
Class / 

Book-Lil 

GqpyrigtoN?- 



COPYRIGHT DEPOSIT. 




\ 




FEMALE PELVIS. 



irl 



TREATISE 

fikl- F 



MEDICAL AND SURGICAL 



DISEASES OF WOMEN, 



WITH THEIR 



ELOMCEOPATHIC TREATMENT. 



gully Illustijatefl. 



- 



BY 



MORTON MONROE EATON, M. D., 

Cincinnati, Ohio. 









BOERICKE & TAFEL, 
NEW YORK, PHILADELPHIA, 

145 Grand Str. 635 Arch Str. 

TRUBNER & CO., 

Ludgate Hill, E. C. LONDON, ENG. 

1880. 







i> 



Copyright Secured, 

AND ALL RIGHTS UNDER IT RESERVED, 
BY THE AUTHOR. 



PREFACE 



In conformity to custom, the Author presents some of 
the reasons which have induced him to present this work to 
the homoeopathic medical profession. 

First. Because he has been for several years repeatedly 
urged to do so, by prominent homoeopathic physicians of 
several States, including representative men in the cities of 
Chicago, St. Louis, New Orleans, Boston, Louisville and 
Cincinnati. 

Secondly. Because homoeopathic colleges have been 
obliged to recommend, and homoeopathic physicians and 
students have been obliged to provide themselves with, 
allopathic works upon these diseases ; thereby giving a certain 
amount of sanction to the treatment therein advocated, and 
causing the use (among otherwise good homoeopathic phy- 
sicians) of caustics, scarifications, etc., applied to the uterus, 
to become so common among them as to bring a blush of 
shame to the face of the true homoeopath. In the use of 
pessaries and drugs, the homoeopathic profession have also 
inadvertently been following, in part, their old-school breth- 
ren's treatment ; because they largely have been obliged to 



IV PREFACE. 

study the description, etiology, diagnosis, pathology, and 
prognosis of these diseases from their books. The homoeo- 
pathic books which we have had upon the diseases of 
women, though written by gentlemen of high standing, do 
not seem to meet all the requirements of the profession, 
though excellent, so far as they go. 

Thirdly. Because it seems time that homoeopathists 
should have complete text books on all branches of medical 
education ; the large increase in the number of homoeopathic 
physicians from year to year justifying the expectation, that 
erelong we may rival the old school in numbers, as we now 
do in the intelligence and wealth of our patrons. 

Fourthly. Because the homoeopathic physicians of Illinois 
and Ohio, in their State societies, and of the North-west, in 
the Western Academy, have honored him with their con- 
fidence, and shown their respect by giving him prominence 
in regard to these diseases, and because he has had a large 
experience in their treatment for over twenty years, in 
hospital and private practice (allopathic and homoeopathic). 

He has endeavored to make this work as complete as 
possible. How far he has succeeded, the profession must 
judge. He believes the works upon the diseases of women, 
by Thomas and Emmet, of the old school, are ordinarily 
considered complete; but he finds that Prof. Thomas* omits 
in his index, Lacerations of the Cervix Uteri; and Prof. 
Emmet f omits Areolar hyperplasia of the uterus, Hydatids of 
the uterus, Rectocele, Sterility, Inflammation of the uterus, in 
all forms, except as he refers to congestive hypertrophy, Abor- 
tion, Pudendal hemorrhage and Pudendal hematocele. And 

* Thomas' Diseases of Women. t Emmet's Prin. and Prac. of Gyn. 



PREFACE. 



both Profs. Thomas and Emmet omit Hysteralgia, Puerperal 
fever, Puerperal phlebitis, Mammary Abscess, Cervicitis, 
Sympathetic Affections, and Nymphomania, as well as Puer- 
peral mania. He is hopeful that this work will not be found 
less complete. 

Neither Dawson's improved Sims' speculum nor Wocher's 
bi-valve speculum are mentioned in either of these works, or 
those of any other author on Diseases of Women (so far as 
he is aware), and they need but to be seen to be appre- 
ciated as decided improvements. Cutler's suture cutter and 
forceps, his own improvement of the London Abdominal 
Supporter, his needle holder, and wire holder and twister, for 
vaginal fistulse, have not heretofore been presented to the 
profession. 

He has spared no pains or expense to have his illustra- 
tions perfect and complete. In this he is greatly indebted to 
Mr. John H. Bogart, designer and engraver, of this city. 
He has not attempted to make a Materia Medica, but has 
named such remedies as he has found beneficial, and given 
the prominent homoeopathic indications for their use in each 
disease, gleaning somewhat from other authors, as well as 
his own experience. 

The Author, in conclusion, would express his thanks to 
Drs. S. R. Beckwith, of Cincinnati; W. H. Hunt, of Cov- 
ington, Ky. ; M. B. Pearman, of St. Louis; T. P. Wilson, 
of Ann Arbor, and others, for valuable suggestions. 
Respectfully, 



M. M. EATOX 



Cincinnati, O., 

U. S. A. 



TABLE OF CONTENTS. 



CHAPTER I. 

Page. 

Introduction, 17 

CHAPTER II. 

General Diagnosis, 21 

CHAPTER III. 

Normal Menstruation, and Amenorrhcea, 31 

CHAPTER IV. 

Menorrhagia and Metrorrhagia, 41 

CHAPTER V. 

Dysmenorrhcea, or Painful Menstruation, 46 

CHAPTER VI. 

Vicarious Menstruation, 56 

CHAPTER VII. 

Inflammation of the Female Genitalia, 60 

CHAPTER VIII. 
Metritis, 77 

CHAPTER IX. 

Areolar Hyperplasia of the Uterus; or, Chronic Parenchyma- 
tous Metritis, 87 



VIII TABLE OF CONTENTS. 

CHAPTER X. 

Page. 

Peri-Metritis — Pelvic Cellulitis— Pelvic Abscess, . . . 110 

CHAPTER XL 

Child- bed Fever — Puerperal Peritonitis, Puerperal Metritis, 
Metro-Phlebitis, and Peritonitis, 126 

CHAPTER XII. 

Homoeopathic Remedies, . . 137 

CHAPTER XIII. 

Instruments, 142 

CHAPTER XIV. 

Induration and Hypertrophy of the Cervix Uteri — Vaginismus 
and Dyspareunia, • . . 162 

CHAPTER XV. 

Ulceration of the Os Uteri, . . . . . . . .179 

CHAPTER XVI. 

Vaginitis— Adhesions in the Vagina from Inflammation — Diph- 
theritic Inflammation of the Vagina — Peri- Vaginitis Phleg- 
monosa Dissecans, 186 

CHAPTER XVII. 

Imperforate Hymen — Atresia of the Hymen (Congenital and 
Acquired) — H^matometra, Etc., . . . • . . . 197 

CHAPTER XVIII. 
Uterine Hemorrhage, 201 

CHAPTER XIX. 

Cervicitis and Endo-cervicitis, or Catarrh of the Cervix, . 211 

CHAPTER XX. 
Endo-Metritis, 218 

CHAPTER XXI. 

Leucorrhcea— Whites, 240 



TABLE OF CONTENTS. IX 

CHAPTER XXII. 

Page. 

Barrenness and Sterility, .249 

CHAPTER XXIII. 

Diseases of the Ovaries, 265 

CHAPTER XXIV. 

Ovarian Tumors, 275 

CHAPTER XXV. 

Ovariotomy, 312 

CHAPTER XXVI. 

Uterine Fibroma — Myoma — Fibrous Tumors of the Uterus, . 342 

CHAPTER XXVII. 

Uterine Polypi — Vegetations of the Endometrium — Uterine 
Hydatids —Vascular Polypi — Placental and Granular Pol- 
ypi, Etc., 352 

CHAPTER XXVIII. 

Moles in the Uterus, 375 

CHAPTER XXIX. 

Catarrh of the Uterus and Vagina, 380 

CHAPTER XXX. 

Hernia of the Ovary— Hernia of the Uterus, or Hysterocele, 385 

CHAPTER XXXI. 

Prolapse of the Vagina, Cystocele, Rectocele, Enterocele, and 
Ovariocele, 389 

CHAPTER XXXII. 

Papillary Tumors of the Uterus and Ovaries, and Coccygodynia, 395 

CHAPTER XXXIII. 

Cancer and Cauliflower Excrescence of the Uterus — Carci- 
noma, Sarcoma, Etc., 400 

CHAPTER XXXIV. 

Femoral Hernia, Inguinal Hernia, Labial Hernia, Vaginal 

Hernia, and Hydrocele, . 404 



X TABLE OF CONTENTS. 

CHAPTER XXXY. 

Page. 

Hydrometra — Pruritus Vulvae— Abscess of the Labia — Cysts of 
the Vagina— Fibroids of the Vagina— Polypi of the Vagina- 
Prolapse of the Ovaries, 406 

CHAPTER XXXVI. 

Abortion, .' 42i 

CHAPTER XXXVII. 

Cysts of the Broad Ligament and Diseases of the Fallopian 
Tubes, 437 

CHAPTER XXXVIII. 

Diseases of the Urethra— Urethritis, Caruncles of the Ure- 
thra, Irritable Urethral Caruncul^e, Ulceration, Fissures 
of the Neck of the Bladder, or Meatus Urinarius Internus, 
Lacerations of the Urethra from Dilatation, Prolapse of 
the Urethra, Urethral Polypi, Etc., 445 

CHAPTER XXXIX. 

Tuberculosis of the Vagina— Stenosis of the Uterus, . . .451 

CHAPTER XL. 

Cystitis in Women, 455 

CHAPTER XLI. 

Stone in the Bladder and Ureters, 462 

CHAPTER XLII. 

Sympathetic Effects of Diseases of the Uterus and its Append- 
• ages, . . . 472 

CHAPTER XLIII. 

Pudendal Hemorrhage — Pudendal Hematocele — Thrombus — Rup- 
ture of the Bulbs of the Vestibule, 490 

CHAPTER XLIV. 

Puberty — And the Climacteric Period, 494 

CHAPTER XLV. 

Atresia of the Vagina, and Cervix Uteri— Hematometra, Etc., 502 



TABLE OF CONTENTS. xr 

CHAPTER XL VI. 

Page. 

Fistula— Vesico-vaginal Fistula — Recto- vaginal Fistula— Recto- 
vesical Fistula — Vesico-cervical Fistula — Urethrovaginal 
Fistula— Intestino- vaginal Fistula — Ureto- vaginal Fistula— 
Vesico-uterine Fistula — Peritoneo- vaginal Fistula — Perineo- 
vaginal Fistula— Blind Vaginal Fistula— Fistula in Ano, . 511 

CHAPTER XLVIL 

Lacerations of the Cervix Uteri, 539 

CHAPTER XLVIII. 

Displacements of the Uterus, ........ 552 

CHAPTER XLIX. 

Different Forms of Displacements of the Uterus— Inversion of 
the Uterus, 563 

CHAPTER L. 

Retro-version and Retro-flexion of the Uterus, . . . 578 

CHAPTER LI. 

Ante-version and Ante-flexion of the Uterus, . 598 

CHAPTER LII. 

Prolapsus Uteri and Procidentia, 605 

CHAPTER LIII. 

Laceration of the Vagina — Laceration of the Perineum — Ulcer- 
ation (Tuberculous, Cancerous, and Syphilitic), . . . 629 

CHAPTER LIV. 

Extra-uterine Gestation, 642 

CHAPTER LV. 

Strangury, Dysuria, Ischuria, Retention of Urine, Suppression 
of Urine, Enuresis, Etc., 646 

CHAPTER LVI. 
Gonorrhoea in Women, 650 

CHAPTER LVII. 

Syphilis in Women, 655 

CHAPTER LVIII. 

Diseases and Difficulties of Pregnancy, 660 



XII TABLE OF CONTENTS. 

CHAPTER LIX. 

Page. 

Vomiting in Pregnancy, 672 

CHAPTER LX. 

Puerperal Mania, 688 

CHAPTER LXL 

Diseased and Deformed Nipples — Milk Fever — Abscess of the 
Breast — Tumors of the Breast, Cancer, and Amputation of 
the Breast, . . . . . ' 692 

CHAPTER LXIL 

Phlegmasia Dolens — Puerperal Phlebitis, or Milk leg, . . 705 

CHAPTER LXIII. 

Hypertrophy, and Sub-involution of the Uterus, . . . 709 

CHAPTER LXIV. 

HEMATOCELE, PELVIC HEMATOMA, THROMBUS, ETC., . . . 716 

CHAPTER LXV. 

Elephantiasis, or Hypertrophy of the Clitoris, Labia Majora, 
and Labia Minora, Hermaphrodites, Nonentities, Tumors of 
the Labia, Etc., 723 

CHAPTER LXVI. 

Extirpation of the Uterus — Ablation of the Uterus, Hyster- 
otomy, Etc., 727 

CHAPTER LXVII. 

Hysteralgia — Neuralgia Uteri — Irritable Uterus — Ascites in 
Women, 736 

a* 

CHAPTER LXVIII. 

Bathing — Vaginal Washes— Stomatitis Materna, . . . 744 

CHAPTER LXIX. 

Nymphomania ( The " Fureur Uterine " of the French) — Atrophy and 
Hyper-involution of the Uterus — Absence of the Uterus — 
Malformation of the Uterus — Anaesthetics, .... 750 

CHAPTER LXX. 
Hysteria, 757 



ILLUSTRATIONS 



Alphabetically Arranged. 



Page. 
ABSENCE of the uterus, .... opp. 723 
Ante-version of the uterus, . . . " 598 
Ante-flexion " ■' ..." 599 

Antiseptic spray apparatus, . . " 150 

Applicator sponge tent, 36G 

" uterine, Emmet's, .... 3G6 

" . " Palmer's, . . . .715 

Artery forceps, 322 

Ash ton's perineum needle, . . . opp. 150 
Aspirator, Tiemann & Co.'s, . . " 153 

" Dieulafoy's, " 154 

Atresia of the vagina, 503 

BABCOCK supporter, ..... opp. 140 
Battery, Faradic, 38, 160, 714 

" combination, 38 

Bed swing, 339 

Bi-valve speculum, vaginal, . . opp. 143 

" " urethral, .... 446 

Bony pelvis, female, . . . opp, title-page. 

Bozeman's tenaculum, opp. 158 

" curved scissors, 523 

" straight scalpel, 636 

CALLENDER'S drainage canula, opp. 158 
Canula drainage, . . . 333, and " 158 

Catheter, reversible, 457 

" self-retaining, .... opp. 158 

Cervix uteri, hypertrophy of, ... . 162 

" " elongation of, . . . opp. 609 

" " amputated (two tigs.), 169 

" double, 755 

Chair examination, 22 

Civiale's lithotriptor, opp. 147 



Page. 
Clamps for pedicle of ovarian tu- 
mors, opp. 161 

Clamp, Tliomas', il 161 

" Dawson's improved, 321 

" Spencer Wells' original, opp. 161 

" " " new (three figs.)," 161 

Clitoris, hypertrophy of, ... . " 723 

Combination battery, 38 

Complete procidentia uteri, . . opp. 611 
" inversion of the uterus, " 563 

Counter pressure hook, 521 

Curved scissors, 530 

" " Bozeman's, 523 

" " long, 146 

" Emmet's, 726 

Cutler's suture cutter and forceps, . . 535 

DAWSON'S pedicle clamp, improved, 321 
" Sims' speculum, . . opp. 142 

Depressor, vaginal, 522 

Dieulafoy's aspirator, opp. 154 

Dilator, uterine, "147 

" sponge tent, " 153 

" vaginal, " 145 

Double tenaculum forceps, 323 

" uterus, 754 

" cervix uteri, 755 

" uterus and vagina, 503 

Drainage tubes, .... 333, and opp. 158 
Dressing forceps, uterine, . . . . *' 144 

EATON'S needle-holder in use, . . .527 
" " " ... opp. 145 

" wire holder and twister, . " 145 



XIV 



ILL USTRA TIONS. 



Page. 
Eaton's wire holder and twister, 

applied, opp. 145 

" improved London sup- 
porter, " 157 

Ecraseur, Edwards', 869 

Edwards' Ecraseur, 369 

Elastic pessaries, 149 

11 abdominal supporters, . opp. 157 

Electrode, intra-uterine, 714 

Electrolysis needles (one fig.), . . . 160 
" " (seven figs.), . . 370 

Elevation of the uterus, . . . . opp. 718 
Elevator, Elliott's uterine, ..." 159 
Elliott's uterine elevator, ..." 159 
Elongation of the cervix uteri, . " 609 
Emmet's sponge tent applicator, 597, 366 

" curved scissors, 726 

" sponge dilator, .... opp. 153 

holder, 326 

" counter pressure hook, . . . 521 

" speculum, • . . 635 

Enlargement of the clitoi-is, . . opp. 723 
Enucleators, Sims' (three figs.), . . . 365 

Endoscope, urethral, 446 

Examination chair, 22 

Exploring trocar, opp. 154 

Extirpated uterus, 733, 734 

FARADIC batteries, ... 38, 160, 714 

Female form, opp. title page. 

" pelvis, bony, . . " " " 
Fibroma of the uterus, . . . 343, 352, 354 

" " cervix, 343 

" uterine, subserous, 343 

" " submucous, .... 343 

" . . 352, 354 

Fibroids, syringe for injecting, . . . 171 

Fistula, vaginal, 524, 526, 527 

" " opp. 535 

Forceps, vulsellum, " 154 

" Nelaton's tumor, . . . ,; 156 

" " pedicle, 365 

" straight lithotomy, . . opp. 147 

" « needle, 526 

» artery, 322 

" double tenaculum, 323 

" uterine dressing, 184 

" " ... opp. 144 

« Greenhalgh's, 208 

" Cutler's suture, 535 



Page. 
Front view of uterine organs, . opp. 17 
Furguson's mirror speculum, . . " 143 

GREENHALGH'S forceps, 208 

HEMATOCELE, recto-vaginal, opp. 718 

Haematometra (two figs.) 503 

Hermaphrodite, opp. 723 

Hypertrophy of the uterus, 710 

" of the clitoris, .... opp. 723 
" u labia majora, . " 726 

" " « minora, . " 725 

" " cervix uteri, .... 162 

Hysterotome, White's, opp. 144 

" Simpson's. .... " 144 

IMPROVED London abdominal sup- 
porter, opp. 157 

Imp'd Peaslee perineum needles, " 145 

Inflatable pessary, 149 

Inhaler, Lente's modified, . . . opp. 156 

Intra-uterine electrode, 714 

Inversion of the uterus, .... opp. 563 

LACERATION of the perineum, . . 635 
u of the perineum, adjusted, 638 
" " " sutures placed, 635 

Lente's inhaler, opp. 156 

Ligature cutter, 535 

Ligatures, 169, 346 

Lithotomy forceps, opp. 147 

Lithotriptor, " 147 

Little's antiseptic spray apparatus, " 156 

'' trocar, " 159 

London abdominal supporter (old), {i 157 
" tl " improved, " 157 

Long curved scissors, 146 

" " trocar, 125 

" " " (uterine), . . . .510 

M'INTOSH'S supporter, 150 

Mirror speculum, opp. 143 

Mucous polypi, uterine, 352 

NEEDLE HOLDER, Eaton's, 527, opp. 145 

" " Sims', 526 

tl " curved, . . opp. 145 

" " straight, .... 526 

Needles, Pease's, 148 

" suture, curved, .... opp. 158 



ILL USTRA TIONS. 



XV 



Page. 
Needles, suture, full curved, . . " 158 

" perineum, " 156 

" " Ashton's, . ..." 156 

" " Peaslee's improved, " 156 

" open-eyed, 326 

" electrolysis, 160 

" " (seven figs.), . . 370 

Nelaton's pedicle foi*ceps, 365 

" tumor forceps, .... opp. 156 
Nelson's tri-valve speculum, . . " 143 

Nonentity "723 

Nott's depressor, 522 

OLD WOMAN'S uterus, 27 

" " vagina, 27 

Old London abdominal supporter, opp. 157 

Open-eyed needle, 326 

Operating tables, 319, 703 

Operation for lacerations of perineum, 635 

" " vesico-vaginal fistula, opp. 535 

" 524, 526, 527 

Original speculum, Sims', . . . opp. 142 

" clamp, Spencer Wells', . " 161 

" London supporter, ..." 157 

Os uteri, virgin, 26 

" '* old woman's, 27 

PALMER'S uterine dilator, . . . opp. 147 

" applicator, 515 

Peaslee's perineum needles, . . opp. 156 

Pease's needle (perineum), 148 

Pedicle clamps (four figs.), . . . opp. 161 
" " Dawson's improved,. .321 

Pelvic lisematocele, opp. 718 

Pelvis, female, bony, . . . opp. title page. 

Pessary, inflatable, 149 

" elastic ring, 149 

Perineum, operation for restoring lac- 
eration of, 635 

" restored after laceration of, 638 

Polypi, mucous uterine, 352 

" fibrous uterine, . . . 343, 352, 354 

Procidentia uteri, opp. 609 

" complete, . . . " 611 
Prolapsus uteri, .... opp. 605 and 710 

" " opp. 606 

"608 

QUILL, suture, adjusted, 038 



Page. 
RECTO- VAGINAL hematocele, opp. 718 

Repository White's uterine, 573 

Retractor, Emmet's vaginal, .... 635 
Retro-version of the uterus, . . opp. 578 
Retro-flexion " " ..." 580 

Reversible catheter, 457 

Round elastic pessary, 149 

SCALPEL, Bozeman's, 636 

Scissors, " 523 

curved, 530, 726 

Self-retaining catheter, .... opp. 158 
Side view of uterine organs, . . opp. 21 

Sims' uterine elevator, " 159 

" enuclcators (three figs.), .... 363 

" needle holder, ......... 526 

" original speculum, .... opp. 142 

" folding " . ..." 142 

" Dawson's imp. " . . . . " 142 

" vaginal dilator, " 145 

" sponge holder, 326 

" sponge dilator, opp. 153 

'* enucleators, 347 

Simpson's sound, opp. 144 

" hysterotome, . . . . " 144 

Skene's sound, " 144 

" urethral endoscope, 440 

Sound, steel, opp. 144 

" Simpson's, " 144 

* Skene's, " 144 

Speculum, urethral bi-valve, .... 446 

" Skene's, 446 

" Sims' (three figs.), . . opp. 142 

" Wocher's bi-valve, . . " 143 

" Nelson's tri-valve, . . " 143 

'' Furguson's mirror, . . " 143 

" Emmet's vaginal, .... 635 

Spencer Wells' trocar, 320 

" " artery forceps, 322 

'' lt pedicle clamp (orig'l), opp. 161 
" " " " new, (three figs.), " 161 

Sphygmograph, 161 

Sponge tents, 150 

Sponge tent applicator, 366 

" " holder, 597 

" " dilator, opp. 153 

" " sponge holder, 326 

Subserous fibi'oid of uterus, 343 

Submucous " " " 343 



XVI 



ILLUSTRATIONS. 



Page. 

Swing, bed, 339 

Sub-involution of the uterus, .... 710 

Supporter, Babcock's, opp. 14G 

t( old London abdominal, . . " 157 
" impr'd Lond. abd'l, Eaton's, " 157 

" silk elastic, " 157 

» M'Intosh's, 150 

Suture cutter and forceps, 535 

" needles, curved, .... opp. 158 

" " half curved, . . " 158 

Sutures in cervix uteri (two figs.), . . 169 

Syringe for injecting uterine fibroids, 171 

TABLES, operating, 319, 703 

Tenaculum, Bozeman's, .... opp. 158 

" double, 323 

Thomas' pedicle clamp, .... opp. 161 
Tiemann & Co.'s aspirator, . . . " 153 

Trocar, common, 391 

" exploring, opp. 154 

" long curved, 125 

" " " uterine, 510 

» Spencer Wells', 320 

" Little's, opp. 159 

Tri-valve speculum, Nelson's, . . opp. 143 

Tumor forceps, Nelaton's, 3G5 

« " " .... opp. 150 

UTERINE organs, normal posi- 
tion, opp. 17, 21 

" dressing forceps, . . 184, opp. 144 
« elevator, Elliott's, ... " 159 

« " Sims', " 159 

" repositor, White's, 573 

" fibroids (three figs.), .... 343 
" " syringe for injecting, .171 



Page. 

Uterine polypi (mucous), 352 

" (fibrous), .... 352, 354 
. " dilator, Palmer's, .... opp. 145 

Uterus, hypertrophy of, ... . 162, 710 

" sub-involution of, 710 

" virgin, 26 

" old woman's, 27 

" double, 503, 754 

" extirpated (two figs.), . . 733, 734 

" elevation of, opp. 718 

" prolapse of, . . opp. 605, 606, 609 

" " " opp. 710 

'* versions of, . . . . opp. 578, 598 
" flexions of, .... " 580, 599 
" procidentia of, . . . " 609, 611 

" absence of, opp. 723 

" drawn out in sight, ..." 535 

VAGINA, old woman's, 27 

" atrophy of, opp. 723 

" atresia of, 503 

" double, 503 

Vaginal dilatoi-, opp. 145 

" pessaries, 149 

'* specula (three figs.), . . opp. 142 
u u a « ; . . « 143 

Virgin os uteri, 26 

Vulsellum forceps, .... opp. 154, 535 

WELLS' artery forceps, 322 

il pedicle clamps (4 figs.), opp. 161 
" trocar, 320 

White's uterine repositor, 573 

Wire holder and twister, Eaton's, opp. 145 
" « " applied," 145 

Wocher's bi-valve speculum, ..." 143 



Plate I. 




FRONT VIEW OF UTERINE ORGANS IN THEIR NORMAL POSITION. 



THE 



DISEASES OE WOMEN 



CHAPTER I. 

INTRODUCTION. 

To-day the diseases peculiar to women are daily brought 
to the attention of the general practitioner of medicine. It 
is a fact that these diseases are on the increase to an alarming 
extent, and bid fair to seriously affect coming generations, 
physically and morally. 

The world has a right to look to the members of the med- 
icnl profession for advice on matters of this kind, and I judge 
the profession would come short of its duty did it fail to point 
out, and seek to remedy, the causes which have led to, and 
are increasing, this great amount of female suffering and dis- 
ease, thereby enfeebling the offspring which are to come for- 
ward on the stage of action, in a few years from now, as the 
business men, statesmen, and those who must fill the posts of 
responsibility. 

May we not, then, in view of the necessities of the times, 
spend a short time in consideration of the causes that have 
produced this increase of the diseases peculiar to women ? 

First, the advancements of civilization, so called, have 
caused a life of luxury and ease to supplant that of toil and 
exercise. The necessity of exercise is as imperative with the 
female as the male. Strong muscle, active digestion, and as- 
similation are not the result of indolence, but of activity. 

Again, our food of late years has been too fine. Pastries, 



18 EATON ON DISEASES OF WOMEN. 

fine flour, and highly seasoned food have driven out of use, 
almost, the plain bread and milk and mush and milk of our 
fathers. 

Again, the fashion of lacing the chest and upper part of 
the abdomen has been, perhaps, the most fruitful cause of the 
long train of women's ailments and weaknesses. By con- 
tracting the thorax the action of the heart is impeded, the 
lungs are prevented from a full expansion, the blood is con- 
tinually charged with too large a quantity of carbonic acid 
gas. Oxygen is not received into the blood in sufficient quan- 
tities to stimulate healthy nerve action, and the result, of 
course, is lassitude, debility, and disease. 

Another injury resulting from lacing the upper part of the 
abdomen is, that the abdominal organs are thereby displaced 
downwards, and press heavily upon the uterine organs. These 
are thereby displaced and inflamed, producing not only the 
symptoms resulting directly from these conditions, but an 
immense amount of trouble through reflex action on the cer- 
ebrospinal and sympathetic nervous systems, thereby derang- 
ing all the normal functions of the body, and sometimes the 
mind as well. 

The wearing of clothing suspended from the hips aids in 
producing all the ills just mentioned, as resulting in greater 
or less degree from lacing. Thin clothing, especially upon the 
extremities, in winter, conjoined with the previously men- 
tioned customs, is not to be forgotten as one cause of female 
suffering. 

And, finally, the cause Avhich, we must recollect, is the 
in-eat curse of the American ladies is to be found in those 
means used to prevent pregnancy and produce abortion. 
The disinclination of so many married ladies to become moth- 
ers has led them to adopt means for the prevention of concep- 
tion that have had the effect of producing diseases in them- 
selves of a serious nature. The various means used to pro- 
duce abortion have entailed on many a lady life-long suffering. 



IN TR OD UCT10N. 1 9 

These remarks may be sufficiently explicit in this connection. 
(See chapter on Abortion.) 

These causes have led to so many ailments, directly and 
through reflex action, that the general practitioner seems 
obliged to become conversant with the diseases of women, 
and we think he should be better informed in regard to these 
ailments than any other, because they are more delicate to 
manage, and it is not always that the patient will volunteer 
information in regard to them. And when investigation is 
thought to be necessary by the physician the patient shrinks 
from it, and purposely misleads ihe physician in describing 
her symptoms, so as to convince him that the difficulty is in 
the head, liver, back, or stomach, when it is clear that all the 
symptoms are due to uterine disease or displacement. 

Let me recommend that the student, before entering upon 
the study of diseases of women, become very familiar with the 
anatomy of the female genitalia, and the arrangement of the 
sympathetic ganglia throughout the entire system. Let him 
read well the physiology of the healthy female, that devia- 
tions from health may be readily recognized, recollecting, 
however, that there are some exceptions to general rules. 
That some women may normally menstruate every two or 
three or five weeks; that the flow may with some be three 
times in amount of what others would discharge, and still 
they might only have this idiosyncrasy, and be not diseased 
at all. By the study of the healthy subject he will learn that 
owing to the varying lengths of the vagina, in different women 
the position of the uterus that would in one case be partial 
prolapse would in another be normal. Hence, it will be 
seen, that the greater the knowledge we have of the peculiar- 
ities of different women, as well as the general knowledge of 
the normal conditions, the greater will be our opportunities 
to judge correctly of the cases we may have to treat, and the 
more correct will be the diagnosis which we will form (if the 
diagnosis of the case is all that is asked of us). 



20 EA TON ON DISEASES OE WOMEN. 

It may be well to mention that the early introduction into 
society of girls of tender age, the desire of mothers to make 
young ladies of their girls when they should be considered 
children, requiring them to refrain from that active exercise 
that is so necessary for the full development of muscle and 
strength; the early marriages so frequently consummated, 
together with the constitutional debility inherited from moth- 
ers already affected with weaknesses dependent upon errors 
of their diet, clothing, and exercise in early life, — all tend 
to enfeeble the constitution and develop special weaknesses 
and diseases. 



Plate II 




SIDE VIEW OF FEMALE PELVIC ORGANS IN NATURAL POSITION. 



GENERAL DIAGNOSIS. 21 



CHAPTER II. 

GENERAL DIAGNOSIS. 

It is not every patient with uterine disease that will come 
to the physician and announce that she is suffering with such 
an ailment; that is, they do not go to the general practitioner 
in this way (though the acknowledged gynaecologist has the 
advantage in this respect, as the patient's presence in his 
office is an announcement of some such ailment, and he is at 
liberty to suppose his patient has been convinced that she is 
suffering from some disease of the female generative organs, 
and has come for examination and advice) ; hence, it becomes 
necessary that the general practitioner look for indications of 
these ailments among the symptoms given by the patient. 
Some of these symptoms, that may point to uterine difficul- 
ties, are, pain in the occiput, or top of the head, burning heat 
in top of head and soles of feet, hot flashes of long standing, 
too frequent or painful micturition, persistent constipation, 
bleeding piles, pain in small of back and thighs, nausea, loss of 
appetite, indigestion, etc. Either of these symptoms, alone, 
would not assure you of uterine disease; but either of them 
gives you cause to investigate further. First, note how long 
these symptoms have existed, how much treatment they have 
had with a failure to obtain relief; inquire further, and ascer- 
tain if we have two or three, or more, of these symptoms in 
the same case ; also, if there is dysmenorrhoea, amenorrhoea, 
menorrhagin, or leucorrhcea — if so, of how long duration, 
noticing all the peculiarities of each case in these regards. 
Take into account the age of the patient, whether married or 
single, widows or spinsters, mothers or barren. 

When all these things are considered, and the difficulty 



22 



EATON ON DISEASES OF WOMEN. 



has been of long standing, and we feel assured that our 
patient's sufferings are caused from uterine disease, we are 
justified in requesting a physical examination, per vaginam. 
This does not contemplate any exposure of the patient, and 
consists of a digital examination, and taking note of the 
dryness or moisture of the vagina, heat, size of neck of 
uterus, whether smooth, nodulated, or fissured; also, its posi- 
tion in the vagina, etc., — all this may be determined with the 
patient standing. 




jSssP 



Fig. No. 1. — Examination Chair. 

(Mitchell, Rammelsberg & Co., Cincinnati, O.) 



Very chronic and severe cases, of course, will demand 
more careful examination with the uterine sound, and some- 
times we may need the aid of the vaginal speculum as well, in 
aid of diagnosis. I value the uterine sound much more highly 
than the vaginal speculum. In many cases, as I have hinted, 
neither of these instruments is needed. Introducing the vagi- 
nal speculum in all cases, as has become the routine habit of 
some gynaecologists, is not to be commended or followed. 
Its use may be required in treatment much more frequently 



GENERAL DIAGNOSIS. 23 

than in diagnosis. To make a vaginal examination I prefer to 
have the patient sit in a regular examination chair. (See Fig. 
No. 1.) It is less embarrassing to the patient; it seems more 
modest; it is more convenient for the physician. Let the 
cover be thrown over her lap while sitting in the chair, and 
then gently tip the chair backwards. The patient is thus 
placed in the reclining posture without scarcely realizing the 
fact. Some gentle examination of the size of the abdomen, 
with slight percussion external to the cover, to ascertain if 
there is much tympanites or tenderness, tends to assure the 
patient, when we may gently slip the clothing upwards with- 
out disturbing the cover, and pass the extended palm of the 
hand over the abdomen, first over one or two thicknesses of 
clothing, then in direct contact with the flesh. By this exam- 
ination we have determined the presence or absence of ten- 
derness, heat, and tympanites and have, in many cases, deter- 
mined whether or not we have ovarian tumors of large size, 
pregnancy of several months' duration, or any large fibroids 
of the uterus. 

I do not mean to say that this external examination will be 
conclusive as to the diagnosis of any of these conditions, except 
regarding tenderness, tympanitis, and heat; but I do say that 
this manipulation will materially assist in the special diagnosis 
which I will explain in detail under the proper special heads. 
This examination gives further advantage, viz., that our patient 
has by this time become somewhat accustomed to manipula- 
tion, and, being assured by this method of examination under 
the cover, that she is not to be exposed or rudely handled, 
we will have little difficulty to proceed in making a digital 
examination per vaginam, following that by examination with 
the uterine sound, and finally with the speculum, if need be. 

Gentleness, and the most respectful demeanor, will win 
the confidence of our patient, and greatly promote the success 
of the treatment used; for, without the confidence and respect 
of his patient, the physician will fail in receiving that careful 



24 EATON ON DISEASES OF WOMEN. 

attention to his directions and co-operation in the treatment 
which is so essential for success in any disease, but more es- 
pecially in those peculiar to women, as, owing to their deli- 
cacy, it is necessary that much of the treatment be carried 
out by themselves. The physician has not the opportunity to 
frequently examine the case, or apply treatment, as in other 
ailments. 

The general appearance of the patient is to be studied, and 
the diathesis noted. The cancerous cachexia, which is indi- 
cated by the sallow, brownish yellow complexion, combined 
with the anxious, wearied, sunken countenance, is to be rec- 
ognized at a glance. The tuberculous cachexia is indicated 
by the shrunken features, the bright, glassy eye, the hectic 
cheek, emaciation, with the hopeful condition of mind of the 
patient, conjoined with the slight or severe cough, which the 
patient always insists is but a slight cold. The location of 
the tuberculous matter may be in the lungs, liver, bowels, 
brain, or other parts of the system. But if we have the 
tuberculous or cancerous cachexia clearly defined, we must, 
of course, address the treatment to the general condition of 
the patient, being assured that unless we are able to bring 
the system to a better standard of health we will have little 
reason to hope for a favorable termination of the case, what- 
ever special ailment the patient may have. To what extent 
these conditions or diatheses may be removed with proper 
remedies I will state under their proper chapters. 

A question may arise in the mind of the physician as to 
the propriety of suggesting a physical examination in case 
the patient is an unmarried lady. Some seem to think these 
cases should never be subjected to physical examination, and 
let them suffer on. Now, while I would not propose a phys- 
ical examination of the virgin as soon as I would in the case 
of a patient that had been married, and Avould try to avoid 
the necessity of making an examination, still, if the case 
seemed to require it very urgently, on account of the long 



GENERAL DIAGNOSIS. 25 

duration of the difficulty, or the intensity of the suffering, I 
would proceed to make the examination without hesitation. 

I will relate two or three cases only, as examples of many 
that have come under my notice and treatment, that will 
show how great the necessity for an examination that some- 
times exists in these cases, that the patient's life may be 
saved, not to mention the saving of suffering and impairment 
of constitution by neglect. 

In 1870 a young lady from a town some thirty miles dis- 
tant, whose age was about twenty-eight years, consulted me 
about a persistent ague, as she called it, of two years' dura- 
tion. On inquiry, I learned that her chills were nervous, 
clearly; that she had hot flashes at irregular intervals; had 
much back-ache, constipation, severe dysmenorrhoea, with 
much nausea and excruciating headaches, heat in the top of 
her head, cold feet and hands. She had taken every medicine 
that three physicians of different schools could suggest, and 
found no relief. I suspected uterine displacement as the 
cause of her ailments; made an examination per vaginam at 
once, found retroversion of the uterus, restored the organ, 
gave her Nux 3 X three times a, day, and she was soon well, 
every symptom having disappeared. 

Case Second. — A young lady, aged about thirty years, 
was brought to me, four years since, by her sister, whom I 
had previously treated, and I found her complaining of a, 
fish-bone in her throat. I examined carefully, even using the 
probang, and finding no obstruction in the throat or oesoph- 
agus ; and, learning that the trouble had existed over three 
years, and had been treated by several good physicians with- 
out benefit, I concluded this symptom must result from 
reflex uterine irritation, though the patient would acknowl- 
edge no other symptom to corroborate my diagnosis. I asked 
for, and insisted upon, a vaginal examination, which was re- 
luctantly consented to, when I found a prolapsus almost 
amounting to complete procidentia! I restored the organ by 



26 



EATON ON DISEASES OF WOMEN. 



appropriate treatment, and within three days she ceased to 
complain of the fish-bone in her throat. Some little attention 
to maintain the womb in situ was all the case required, and a 
complete cure was the result. 

Case Third. — A miss, aged about twenty-three years, con- 
sulted me, about four years since, as to her cough, that had 
existed some three years, and resisted all treatment. On 
inquiry, I found that menstruation had been getting more and 
more scanty for three or four years, until it was entirely 
absent for some six months past. I made, or rather at- 
tempted to make, a vaginal examination, and found an imper- 
forate hymen completely closing the vaginal orifice. (There 
must have formerly existed a small opening, that had grad- 
ually closed by adhesive inflammation.) I operated on the 
case, assisted by the late and honored Dr. Troyer, of Peoria, 
111., removed a small amount of retained menstrual flow (the 




Fig. No. 2. — Virgin Os Uteri. 

small amount being due to her emaciated condition), and suc- 
ceeded, by proper remedies, in restoring normal healthy men- 
struation. In a few months my patient was fully recovered 
from her cough, and had become rosy and fleshy. 

I might go on relating numbers of cases as striking as 
these occurring in my private practice ; but I do not think a 
work on diseases of women should be very much cumbered 



GENERAL DIAGNOSIS. 



27 



with the detail of cases, and should be only mentioned in 
sufficient number to demonstrate the principle under con- 
sideration. 

It will be seen that we fully believe that it is sometimes 
imperatively necessary to make vaginal examinations in virgin 
patients. In examining the virgin per vaginam, we can gen- 
erally introduce but one finger. This should be well smeared 
with some oily substance. I prefer vaseline, as its healing 
properties make it desirable in case of some slight laceration 
of the hymen, which will usually occur. 

The virgin os uteri is small, round, and smooth, projecting 
into the vagina, about an inch. (See cut No. 2.) It should 
be found a little posterior to the center of the vagina, about 
three or three and a half inches from the hvmen, or mouth 
of the vagina. 

The opening into the virgin uterus is so small it may 
require careful feeling to detect the dent or fissure. In case 
of those ladies who have borne 
children the vagina, is capable 
of receiving two fingers, and 
we can make a much more 
satisfactor}- examination with 
two than with one. In these 
cases we find the neck of 
the uterus larger, the opening 
more distinct. 

In the aoed the os is sit- 
uated normally at the upper 
extremity of the vagina, and 
projects into the vagina little 
or none at all. The anterior, 
posterior, and sometimes the Fig. No. 3.— Old Woman's Os Uteri. 
lateral walls of the vagina are shrunken into bands or tendon 
like cords, that give the upper portion of the vagina a rough, 
irregular, tendonous feel, which we might mistake for dis- 




28 EATON ON DISEASES OF WOMEN. 

ease did we not know this change was peculiar to women 
after the climacteric period has been passed several years. 

Finally, I will agree with Professor By ford in saying that 
a tender uterus is a diseased uterus. Normally, it is not 
tender. It should give no pain to make a thorough examina- 
tion, either digital or with the speculum or sound. If a care- 
ful examination gives pain we may be assured that something 
is wrong; that is, always understanding that a suitable sized 
speculum is used. A speculum of no considerable size should, 
of course, be introduced into the virgin vagina. 

For these examinations I prefer the uterine sound in- 
vented by Simpson, though I desire two or three sized probes 
always at hand. The bi-valve speculum manufactured by 
Max Wocher & Son, of Cincinnati, is the speculum I gen- 
erally use; but in some cases we must have the tri-valve. 
Nelson's is, perhaps, the best. I find little use for the com- 
mon glass instrument recommended by Furguson. Occasion- 
ally a case can best be examined with the aid of Sims' 
slit speculum, but its use requires the aid of an experienced 
assistant. (See chapter on Instruments.) 

The diagnosis of diseases of women has been greatly aided 
during the past twenty-five years by our distinguished coun- 
trymen, Drs. Ludlam and By ford, of Chicago ; Sims' of New 
York; also, Simpson, of England; Kiwisch, in Germany; 
Huguier, in France; and Ziemssen, of Bavaria; though the 
uterine sound and vaginal speculum were known to the 
ancients, Soranus having mentioned their use. 

Conjoined manipulation seems to have been well under- 
stood by Puzos, as far back as 1750. In the excavations of 
Pompeii a speculum was found, the three blades of which 
were expanded by a screw ; but, so far as we can learn, its 
use was not appreciated until within the last quarter of a 
century. 

Anaesthesia is to be employed in cases that can not be 
well diagnosed without its use — such cases are those who 



GENERAL DIAGNOSIS. 29 

suffer from extreme tenderness of the vagina or abdomen, 
and where we feel in doubt of the existence of ovarian tumors 
or tumors of the uterus, owing to the rigidity of the abdom- 
inal muscles. Schroeder* mentions two cases which were 
sent him for ovariotomy, where he found not only no ovarian 
disease, but did not even find a circumscribed abdominal 
tumor. 

A lady was sent me from Kentucky, last year, for ovari- 
otomy, Avho had no disease of the ovary, but a dead foetus in 
the uterus, which I removed, though it presented many 
symptoms calculated to lead one to suppose she had disease 
of the ovary. These mistakes might have been avoided by 
placing the patient under an anaesthetic while making the 
examination. I need scarcely remark that in examinations, 
as well as operations, a competent assistant should administer 
the anaesthetic. 

No physician should be so careless of his reputation as to 
attempt to administer any anaesthetic to a patient without 
the presence of a friend. A lady's imagination is so much 
affected, in some instances, by the anaesthetic that the physi- 
cian might be accused wrongfully by her of improper familiar- 
ities, had he not a friend present to prove his innocence. 

In conclusion of this subject I will say, that in case the 
patient refuses to submit to as thorough an examination as 
the physician thinks necessary, he is perfectly justified in 
not prescribing for the case. By attempting to prescribe for 
cases with an imperfect knowledge of them, the physician 
is almost sure to lose reputation, and the patient loses valua- 
ble time in many cases By being decided about the matter, 
the physician generally commands the respect of the patient, 
and his success will be the means of more extended usefulness. 

Conjoined manipulation, previously mentioned, is made 
by introducing one or two fingers of one hand into the va- 
gina until the cervix uteri is felt, and then pressing the 
* Ziernssen's Cyclopaedia, Vol. X. 



30 EA TON ON DISEASES OF WOMEN. 

fingers of the other hand down into the pelvis from above, 
pressing just above the pubis, and carrying the abdominal 
walls downwards before the fingers into the pelvis. In this 
way the position and diseases of the uterus may sometimes 
be diagnosed. 

In cases of enlargement of the uterus from tumors, or in 
pregnancy, the extended palm of the hand is laid upon the 
hypogastric region, in making this examination, instead of 
pressing down into the pelvis. Rectal examination is some- 
times necessary to determine the diagnosis of disease in the 
pelvis. This is especially the case in the diagnosis of retro- 
version, cellulitis, recto-vaginal hematocele, and some of the 
diseases of the ovary. The student should also bear in mind 
that hemorrhoids, fissures of the anus, tumors in the rectum, 
prolapsus of the bowel, etc., may simulate uterine disease or 
displacement. The second finger should ordinarily be used 
in making a rectal examination, as it is longer than the other 
fingers and consequently enables us to reach higher up in the 
bowel. The finger should, of course, be well smeared with 
vaseline or some oleaginous substance, as in making a vaginal 
examination. In making a rectal examination the patient 
should lie upon her side, with the thighs flexed upon the 
abdomen. Over the patient should be thrown a cover. There 
is no need of any exposure of the person in these examinations 
unless we have reason to suspect fissures of the anus from 
having hemorrhage from the rectum and finding no hemor- 
rhoids, and then the parts can be seen through the slit in the 
cover. In the office we have a cover always- at hand about 
two-thirds as large as a sheet, with a slit about five inches 
long in its center. A slight opening may be made in a sheet 
and be kept, at the house by the patient when Ave make visits 
to her there, in cases requiring frequent examination. An 
ordinary sheet may be used for a cover in an emergency. 



MENSTR UA TION. 31 



CHAPTER III. 

NORMAL MENSTRUATION, AXD AMENORRHEA. 

The term amenorrhoea signifies the absence of the usual 
monthly menstrual flow in women of proper age. where the 
suppression is not due to pregnancy. The menstrual flow, or 
catamenia, commences with girls in this country usually from 
the fourteenth to the sixteenth year of their age. though 
some instances of the appearance of the flow at ten or twelve 
years of age are observed, especially in the Southern States. 
Isolated cases have occurred of menstruation at even an ear- 
lier period. The age when the menses cease is called the 
climacteric period, and occurs at about forty or fifty years 
of age, though exceptional cases have been known of their 
cessation permanently as early as twenty-eight or thirty years 
of age — these cases of early cessation being those who com- 
menced exceptionally early. Still, as a general rule, the girl 
commences to menstruate at about fourteen years of age, and 
continues to menstruate each twenty-eight days till reaching 
the age of about forty-five or forty-eight years. Sometimes 
the commencement of menstruation is delayed till the age of 
seventeen or eighteen is reached ; seldom, however, without 
showing evidences of impaired health, causing the propriety 
of denominating the case one of amenorrhoea. It may com- 
mence at the proper time, and continue for months or years 
regularly, and cease from various causes. This complete 
amenorrhoea usually produces grave effects on the system. 
Again, we may have only a slight show at each monthly 
period. This condition is called partial amenorrhoea. 

The quantity of menstrual flow and its duration varies 
greatly in different women, some only soiling three or four 



32 EATON ON DISEASES OE WOMEN. 

napkins, others ten or twelve ; some have the flow to last 
only two or three days, others six or eight; hence, a condition 
that would be amenorrhoea in one woman, would be a full 
menstruation in another. The physician should learn the 
peculiarity of his patient in this regard at first, if possible, 
that he may better judge the proper amount that should be 
discharged. The interval also varies much; some menstruate 
every three weeks, others every six weeks, and are healthy; 
but these are exceptional cases. Another class of exceptional 
cases are those Avho never menstruate, and are still in good 
health. This class is exceedingly small. 

Symptoms. 

In addition to the absence of the usual menstrual flow, 
we have various symptoms manifesting themselves in amenor- 
rhoea. First, pain in the back and loins at about the time the 
menses should occur; nausea, produced from sympathetic 
nerve action, occasioned by the congested condition of the 
uterus, resulting from the failure of menstruation; acute or 
chronic inflammation of the uterus; anaemia, sometimes result- 
ing from the vitiated sanguification produced from the general 
derangement of the digestive and assimilative process ; head- 
ache, dizziness, lassitude, the white tongue, palpitation of the 
heart, shortness of breath, loss of appetite, and a general 
atonic condition of the system. This latter condition is 
known as chlorosis. 

Another symptom which has been too little recognized by 
authors is congestion of the kings, and is so frequently a con- 
dition resulting from amenorrhoea, that I am surprised that 
more has not been written on the subject. I have frequently 
been consulted in cases that were supposed to be phthisis, 
without any doubt (cases Avhich had been so diagnosed by sev- 
eral physicians), where the cough and emaciation had gradually 
increased for two or three years, and, in one instance I recall 
now to my mind, over six years, where I found the history 



AMENORRHEA. 33 

of the case showed that amenorrhea had been the cause of 
all this trouble, and not a result of this cough and chlorosis; 
and I believe, in every case of this kind that I have had the 
treatment of fully, I have succeeded in establishing men- 
struation, and obtaining entire relief from the cough, with 
great increase in flesh and an entire restoration of strength 
and health. Hence, I would be emphatic in calling the atten- 
tion of the physician to the congestion of the lungs as one of 
the prominent symptoms of amenorrceha. I believe many 
a young lady has filled her grave prematurely for the want 
of proper attention to the cause of her ailments, where they 
have been supposed to be constitutional, and were really 
caused from amenorrhoea. Why authors have failed to make 
more prominent this resultant symptom of amenorrhoea is 
more strange from the fact that many physicians, in conversa- 
tion and in society meetings, have expressed the same expe- 
rience. The length of time that is necessary for the amenor- 
rhoea to exist before these symptoms of the general system, 
lungs, and stomach manifest themselves varies greatly in dif- 
ferent cases. Some will manifest active symptoms of this 
kind at once on the suppression of the discharge, while with 
others the symptoms are delayed several months. More 
generally we have, within a few weeks, backache, pain in 
the iliac and hypogastric regions, loss of appetite, dullness, 
languor, sometimes extreme nervousness, fever, etc., indicat- 
ing active inflammatory action. This is more likely to be the 
case if the suppression has been the result of cold at or about 
the last menstruation. A sense of weight in the pelvis is 
complained of, with tenderness over the lower part of the 
abdomen in some instances. In other cases the symptoms 
are not active, but more moderate in their manifestation. 
We have the headache and backache only, or dizziness is 
complained of, with torpid bowels and want of appetite. 
Other cases show congestion of the lungs as one of the first 
symptoms, being decided at first and gradually becoming less 

3 



34 EA TON ON DISEASES OF WOMEN. 

severe, and still some irritation remaining, with some cough 
and slight expectoration, increasing from month to month. 
In cases of entire absence of menstruation, where the flow has 
never been established and the patient has reached the age 
of maturity, we usually have the symptoms of general decline 
well marked, with less prominent symptoms in the pelvis. 
The digestion and assimilation generally are most impaired in 
this class of cases, and a general anaemia is often diagnosed 
carelessly, when the true understanding of the case shows 
that the retention in the blood of the menstrual fluid, with the 
consequent irritation in the ovaries and uterus, have caused 
this apparent anoemia, and the true treatment is to bring on 
the menstrual flow — not filling the system with iron, how- 
ever, as has been the practice of the old school for a century 
past. Absence of menstruation during lactation is not con- 
sidered amenorrhoea,, but is a normal condition. Anomalous 
cases, where menstruation is entirely absent, and no injurious 
effect is produced on the general system, are to be let alone 
as a general rule. Loewy relates a case where a woman had 
six children previous to her menstruation, which first appeared 
at the thirty-first year of her age. We have in these cases, 
generally, all the external evidences of puberty, with the 
exception that the breasts are rudimentary ; but, as this is 
also observed in many who menstruate regularly, it is not 
peculiar to this class of women. We sometimes have what is 
termed vicarious menstruation, which indicates a flow of blood 
from some other part of the body, as the nose, stomach, or 
bowels. Again, we have a copious leucorrhoeal discharge, 
which seems to take the place of the regular catamenia. 

Etiology. 

The most frequent cause of amenorrhoea is doubtless cold. 
Getting the feet wet, or being exposed to cold with insufficient 
clothing at about the time of the menstrual flow, will often 
cause amenorrhoea, from a sub-acute inflammatory action set 



AMEXORRHCEA. 35 

up in the uterine organs, especially the lining membrane of 
the uterus. This may cause suppression by means of the 
temporary occlusion of the neck of the uterus, from the 
swollen condition of its lining membrane; or the inflammatory 
action may cause an indurated or thickened condition of the 
endometrium, or the exudation of a semi-plastic material may 
prevent the menstrual flow. 

Doubtless, an anaemic condition sometimes causes delayed 
menstruation in the young, and may cause suppression as 
well, as Ave see in cases of typhus and typhoid fevers, and 
other diseases of debility tending to impoverished blood — 
especially is this the case in advanced stages of tuberculosis. 

Psychical influences sometimes produce amenorrhoea. 
Thus great mental depression or great fright may produce 
suppression. (See Parviri on the "Influence of the Mind 
over Menstruation.") Rnciborski and Bohata mention cases 
of amenoiThoea which may occur from great fear of preg- 
nancy, in cases of unmarried girls, or women who have been 
led astray or forcibly violated, and have reason to stand in 
extreme dread of pregnancy. Again, as Ziemssen mentions, 
(on page 328, Vol. X), it seems possible for the period to 
be delayed or fail altogether in women who eagerly desire the 
occurrence of pregnancy, and who look for the appearance of 
the menses with great mental agitation, from fear of being 
barren. Some cases of amenorrhcea seem to result from an en- 
tire absence of sexual strength, there being no sexual passion. 
This want of strength, or torpidity, of the sexual functions 
seems to result from close confinement in convents, the asso- 
ciation with females only, hard study, so as to divert all the 
nerve force to the head at the expense of the sexual system. 
The imperforate hymen, atresia of the vagina, or cervix 
uteri, absence of vagina, uterus, and ovaries, of course would 
prevent menstruation. 

These malformations and accidentally acquired or congeni- 
tal deformities may exist, and the physician be in ignorance of 



36 EATON ON DISEASES OF WOMEN. 

them for a time, as he is not justified in making a physical 
examination of a young lady patient suffering from amenor- 
rhoea, until some remedies have been used to establish the 
function. After they fail to produce menstruation when 
given for a considerable length of time, and the health of our 
patient is greatly impaired, we may proceed to make a phys- 
ical examination of the generative organs. Some patients 
suffering from this difficulty are troubled with severe neu- 
ralgia, not only affecting the uterus and ovaries, but the head, 
face, and sometimes the stomach ; and some have hysterical 
convulsions. These conditions are usually considered results 
of the amenorrhoea; but the nerve symptoms, as well as the 
amenorrhoea, may be due to spinal difficulty, meningeal or 
otherwise. 

Prognosis. 

The prognosis of these cases is usually favorable, though 
it is grave and unfavorable when occurring in connection with 
a case of phthisis. We are to bear in mind, however, that 
the symptoms of phthisis are sometimes resultant from the 
amenorrhoea, and may disappear by curing the suppression, if 
there be not actual disorganization of the lung substance. 
If the case show's only chronic bronchitis, we make a favor- 
able prognosis if the amenorrhoea preceded the cough. Much 
must depend upon the complications of the case as regards 
prognosis. 

Treatment. 

The treatment of amenorrhoea must be adapted to the va- 
rious conditions of the particular case in hand. Recent cases 
of suppression, caused from cold, generally require Aconite. 

Bell, is indicated if there is much weight and pressure in 
the lower abdomen. 

Arsenicum Alb., if there is alternating heat and chilly 
feelings, with thirst. 

Puis., if there is pain in the uterus and ovaries of an 
intermittent character. 



AMENORRHEA. 37 

Cimicif., if the pain is in the ovaries or runs down the 
thighs. 

Bryonia, if the pains are sharp and darting, and worse 
on motion. These remedies, conjoined with the warm foot 
and hip bath, repeated daily, are generally efficient in restoring 
the flow. Cases that exhibit great debility, especially after 
severe illness, will generally require China, Merc, Nux, etc. 

Macrotine is sometimes useful in chronic cases. 

Where the difficulty has been of several months' standing 
in married ladies, and also in case we may have any reason 
to suspect pregnancy, in married or unmarried, the physician 
should be careful to make a clear diagnosis of the absence of 
this condition before continuing treatment. When fully con- 
vinced there is not pregnancy, we may proceed to use elec- 
tricity, placing the positive electrode over the pelvis, and the 
negative to the spine, passing it up and down the lower part 
of the back for five or ten minutes, using only a, mild current; 
or we may introduce directly into the uterine cavity a me- 
tallic electrode, made much like the ordinary uterine sound of 
Simpson, to which is attached the positive pole of the bat- 
tery, the negative applied to the spine as before. (See cut of 
uterine electrode, in chapter on Hypertrophy of the Uterus.) 
This may be repeated, if necessary, in three or four days, 
using always a very mild current of electricity. 

Mustard sinapisms to the small of the back and over the 
hypogastric region are often very efficient. In those cases 
that are obstinate I would rely upon Puis. 3 X or Macrotine 
3 X every three hours, giving occasionally, for a day or two, 
China, Merc., or Ars., while w T e interrupt the Puis, or Mac. 
for that length of time. 

Cases caused by fright, I may say, always demand 
Aconite, except in a few that show decided tendency to 
twitching of the muscles and restlessness, where we may find 
Ignatia, or Verat. alb., indicated. In case of imperforate hy- 
men, of course, we should proceed to make an incision, and 



38 



EATON ON DISEASES OF WOMEN. 



evacuate the menstrual blood that has accumulated in the 
vagina. This is a simple operation, and requires no special 
remarks, except, perhaps, that we must remember to insert 
into the opening we have made a wad of lint or cotton 
smeared with vaseline, so as to prevent the reuniting of the 




Fig. No. 4.— Combination Battery. 

This is a combination of ii thirty-cell Galvanic Battery ami a No 3 Faradic Buttery. The 
above cut shows the method of putting the Battery in action by raising the cells. In application, 
either the slow or the rapid interrupter of the Farndic apparatus can, by simply moving a switch, 
be made to act as an Automatic Rheotome, for interrupting the Galvanic current. In certain in- 
stances this combination of the two Batteries in one case is of great advantage. 

incised hymen. The adhesions in the neck of the os uteri 
may sometimes be broken up with the uterine sound. When 
this can not be done, we may insert into the neck of the 
uterus, through the os, if it is perceptible, or, if not, then 
where it should be, a curved trocar, passing it in till we are 



AMENORRHEA. 39 

sure we have reached the cavity of the body of the uterus, 
being careful not to go too far, when, upon withdrawing the 
stylet, we will generally have a flow of menstrual fluid 
through the canula. I would advise the leaving of the canula 
in the uterus two or three days, having the patient main- 
tain the recumbent position. The canula may be retained 
by means of a wad of cotton placed against the end of the 
canula in the vagina, and retained with a T bandage. Of 
course, these wads of cotton should be removed, and replaced 
with fresh ones, three or four times a day. In about three 
days remove the canula, and daily pass the uterine sound 
through the opening, having it well smeared with vaseline 
before it is introduced. This should be continued a week or 
so. In case of absence of the uterus, or ovaries, w r e can do 
nothing. 

Fortunately these cases show small indications of woman- 
hood, being angular in build, w 7 ith rudimentary breasts, a. 
coarse voice, and generally suffer little, or none at all, from 
the absence of menstruation ; but in cases of well-formed 
uterus and ovaries, with occlusion of the neck, attresia of the 
vagina, or imperforate hymen, it is quite different. 

Some cases of delayed menstruation show no signs of 
general derangement of the system. On the contrary, they 
appear as healthy as any one ; and we are consulted by the 
mother for fear of serious consequences. Generally, in such 
cases, I would recommend Puis. 3 X , a powder three times a 
day, with horseback riding, change of air, etc., which generally 
will set the matter right in a short time. Should there be 
any serious symptoms arising — such as slight cough, shortness 
of breath, dyspeptic symptoms, and the like — the ca&e should 
receive careful attention till the menstruation is established; 
for until then our patient is in imminent danger. The prepa- 
rations of iron I would not recommend, as I have found the 
remedies already suggested much the more efficient. In fact, 
I never observed good effects from Iron in these cases. The 



40 EATON ON DISEASES OF WOMEN. 

leucorrhcea, that sometimes seems to take the place of the 
menstruation, is not to be stopped by astringent vaginal injec- 
tions, as is so often done by the allopaths ; but we are to 
consider that the leucorrhcea is a symptom of the inflamed 
condition of the endometrium, or vagina, and that remedies 
to relieve the inflammation will not only restore the mens- 
trual flow, but will also cure the leucorrhcea as well. Warm 
clothing, especially to the lower extremities, is to be insisted 
upon; suitable bathing and exercise are not to be forgotten. 
Going into society is sometimes beneficial. Changing the res- 
idence from city to country, or vice versa, stopping hard study, 
using sea-bathing or rowing, and having cheerful company, 
etc., with assurance of speedy relief, will do much to restore 
the normal flow. In those cases where the fear of pregnancy 
seems to be the cause of the suppression, I know of no rem- 
edy more efficient than blanks of sugar of milk, with the 
assurance of the physician that they will certainly bring on 
menstruation (if the patient has confidence in her physician, 
and pregnancy does not really exist). Hysteria in these 
cases is treated as in others, coupled with the proper remedies 
to relieve the suppression. 

Caiitliarid.es is sometimes a useful remedy in amenor- 
rhoea, given in low dilutions. The indications for its use in 
these cases are weakness, irritation of the bladder or urethra, 
and especial weak sexual strength, absence of all sexual 
desire, stinging pain in micturition, etc. 



MENORRHAGIA AND METRORRHAGIA. 41 



CHAPTER IV. 

MENORRHAGIA AND METRORRHAGIA. 

The excessive loss of blood at the menstrual period is 
called menorrhagia. In these cases we have, generally, not 
only an excess of quantity, but also excess in the duration 
of the flow. It comes on usually without pain; but if the 
patient is much exposed to cold during the first part of the 
flow, we may have a temporary cessation, followed by some 
forcing-down pains to expel clots that have formed in the 
uterine cavity. The patient is generally much exsanguined, 
and shows evidences of debility. 

In menorrhagia we may have, and usually do have, vari- 
ous complications, such as tenderness over the hypogastrium 
and one or both iliac regions, a sense of weight in the pelvis, 
pain in the small of the back, nausea, headache, etc. These 
symptoms are common, however, to most uterine difficulties, 
and are not pathognomonic of this particular disease. Here 
the excess of flow at the menstrual period is almost the only 
distinctive pathognomonic symptom. If the flow occurs at 
short, irregular intervals, occurring between the periods of 
menstruation, it is termed uterine hemorrhage, or metror- 
rhagia — a difference of name, with no great difference of con- 
dition ; but it is well always to draw careful lines in medical 
nomenclature, as it is only in this way that one physician 
can, by a name, communicate to another the condition of his 
patient. We must bear in mind that a free menstrual flow is 
a conservator of health, and realize that nature is a wise 
physician, and makes no mistakes, and always tries to rectify 
those of others. Hence, we should be slow to interfere with 
active agents to suppress the discharge that is, at best, but a 



42 EATON ON DISEASES OF WOMEN. 

symptom of other ailments, though given, by common con- 
sent, a distinctive name. 

Htiologjr. 

The excessive flow in monorrhagia is due, in some in- 
stances, to overwork ; again, from a too sedentary life, caus- 
ing impoverishment of the blood. An inflamed condition of 
the uterus, in its sub-acute form, tends to promote this 
difficulty. This is favored by miscarriages, and we often find 
this disease as a sequela of abortion. Neglected catarrh of the 
vagina and uterus also favors monorrhagia. Small granula- 
tions in the neck of the uterus, as well as all forms of uterine 
polypi and uterine fibroids, tend to produce excessive flow at 
the regular period. The an semi c condition of the blood, as 
well as great fatigue of body or mind, may greatly aggravate 
the difficulty. My esteemed friend, Prof. Ludlam,* says : 
"In the early stages of phthisis we sometimes meet with 
cases of troublesome, and sometimes dangerous, monorrhagia. 
As a rule, however, it is more liable to occur in the advanced 
stages of the disease." 

This does not accord with my experience, and I have taken 
some pains to obtain the experience of others, and they agree 
with me that, in the advanced stages of phthisis, we uniformly 
have amenorrhoea, instead of monorrhagia ; and we think that 
if a profuse menstrual flow should be present in any excep- 
tional case of the advanced stages of phthisis, it would proba- 
bly be due to uterine polypus or cancer. We have never seen 
this complication of a case of phthisis. 

The capillary congestion that is necessary to the produc- 
tion of monorrhagia may be produced from such a variety of 
causes that we always have to go back of the excessive flow to 
the undue capillary congestion, and again back to the cause of 
this congestion. 

The cold, that in the first instance produced amenorrhoea, 

* " Clinical Lectures on Diseases of Women," R. Ludlam, p. 48. 



MENORRHAGIA AND METRORRHAGIA. 43 

may secondarily produce monorrhagia, from the irritation 
which is left in the mucous membrane of the uterus in some 
instances. 

Treatment. 

The first point in the treatment of monorrhagia is to enjoin 
and insist upon absolute rest, in the recumbent posture. This 
will greatly aid us in the treatment, and without it we will 
generally fail. 

Cold compresses, in the form of cool, wet cloths, applied 
to the hypogastrium, and frequently changed, and cool water 
vaginal injections, may be used with benefit in some cases. 
The tampon in the vagina may be demanded in those cases 
that resist ordinary treatment, still it will be seldom that we 
will see cases of such severity as to demand it, unless the 
cause is uterine polypi, or a single polypus. We are not to 
expect to very often see cases that demand these severe 
measures, and, if the history of the case shows us that the 
flow has been coming on at times in the intervals of the reg- 
ular periods, we may know that we have something more se- 
rious to attend to than ordinary excess of menstruation. The 
flow should not be arrested simply because it is large, for some 
plethoric, full-blooded women lose a large amount, and find 
it consistent with good health. Treatment is only to be used 
when the general health seems to be seriously affected, or the 
exhaustion at each flow is so great as to necessitate remedial 
measures. In the treatment we have also to bear in mind 
that the excessive flow coming on for the first time may indi- 
cate a threatened abortion. The particular condition of the 
general system, and the local condition of the womb, in each 
particular case, are to be studied in the treatment of each 
case, Very often cases, following after confinement or abor- 
tion, have a relaxed condition of the uterus and uterine ves- 
sels, which require Secale cor., in twenty-drop doses of the 
fluid extract, given in a drink of warm water, and repeated 
every twenty minutes till three or four doses have been 



v 



44 EA TON ON DISEASES OF WOMEN. 

taken. This treatment is applicable also in those cases where 
polypus is present. 

This remedy (which to my mind is much preferable to ice 
in the vagina, or ice to the back or abdomen) may act suffi- 
ciently in one dose, and, if so, no more need be given. 
Should a threatened abortion be suspected, and there be 
present some labor-like pains, Secale 3 X or 6 X will generally 
stop the contractions of the uterus and moderate the flow. 

Viburnum Prunifolium l x , given in tea-spoonful doses 
every half hour, is an efficient remedy in true menorrhagia. 

Ipecac, China, Ferrum, Nux, are remedies that are calcu- 
lated to relieve the case if due to debility, general atony, or 
anaemia. 

Aconite, Gelsem., or Ars., are the remedies to be studied 
and used, according to the totality of the symptoms, in those 
cases, of a congestive or inflammatory character, which are 
acute. 

We will do well, in all cases of menorrhagia, to be sure 
of the nature of the case. A thorough examination is often 
necessary, though we are justified in omitting it, in recent at- 
tacks, in some instances. We find the sponge tent to be of 
great service in some cases. It acts as an efficient tampon, 
arresting the flow, and, by dilating the cervical canal, we may 
find the cause to be a polypus, or small granulations in the 
neck of the uterus. If granulations, their vitality is destroyed 
by the tent, and they generally will fall off with the use of 
very little force, and sometimes with none at all. This effect 
of the sponge tent is very evident in those cases where 
it is allowed to remain for eighteen or twenty hours, and 
another immediately inserted and allowed to remain for 
the same length of time. The tampon most convenient to 
be used in the vagina I have found to be the elastic rubber 
bag, with tube and stop-cock (English or French manu- 
facture). The American rubber has very often disappointed 
me in leaking the air and collapsing. Of course, the vagina 



MENORRHAGIA AND METRORRHAGIA. -45 

may be tamponed with old cloths or wads of cotton, but 
the rubber big, or colpeurynter, is much the most convenient 
and desirable. 

The use of the colpeuiynter, or air bag, is called colpeu- 
rysis. Dr. Carl Braun,* assistant physician at the lying-in 
clinic at Vienna, is the inventor of this tampon. The colpeu- 
iynter, as invented by Dr. Braun, consisted of a vulcanized 
gum elastic bag, fitted into a small, hollow cone of horn. It 
has since been modified so that the elastic bag is attached to 
and is continuous with a tube of the same material 18 inches 
or more in length. To this tube a stop-cock is attached, which 
retains the air. The length of the tube makes it more easily 
inflated, and more convenient than the original instrument. 

Merc, Iod., Br?/., Cal. carb., Cimicif., Hamamel, Phos., 
Trillium, etc., may sometimes be homoeopathically indicated 
in menorrhagia or metrorrhagia. (See works on Materia 
Medica for special indications.) Uterine polypi, if present, 
must, of course, be removed. 

*"Klinik der Geburtshilfe and Gynsekologie, " Vol. I, page 126. 



46 EA TON ON DISEASES OE WOMEN 



CHAPTER V. 

DYSMENORRHEA, OR PAINFUL MENSTRUATION. 

Dysmenorrhea is a term used to signify painful men- 
struation ; but it is not all pain occurring at or about the 
menstrual period that should be called dysmenorrhcea. Neu- 
ralgia of the ovaries is a notable instance ; here we have 
severe pain in the ovaries, one or both ; it occurs in some 
instances only at the menstrual epoch, still is neuralgia, and 
should be so designated. The true dysmenorrhceal pain is in 
the uterus, coming on in paroxysms, as a general rule, simu- 
lating the pains of threatened abortion, while the ovarian neu- 
ralgia is continuous and darting. The throbbing, tense pain 
is indicative of ovaritis, and is located in the iliac regions. 

Authors generally seem to consider that the condition of 
the uterus in dysmenorrhcea is one of inflammation, either in 
the uterine muscular tissues or in the internal membrane. I 
differ somewhat, and claim that more cases of dysmenorrhcea 
are caused from retro- or ante-flexion, stenosis, or partial atresia 
of the cervical canal, than from any other causes; though it is 
true that the inflammation in some cases, without doubt, pro- 
duces the pain in the expulsion of the menstrual flow. It also 
tends to the formation of false membrane, that is formed in 
some cases, and thrown off at each menstruation from the mu- 
cous membrane lining the uterus, called nidation. Generally, 
the pain commences several hours, and in some cases two 
days, before any flow is established. The agony suffered in 
some of these cases is terrible. 

Besides the severe pains in the uterus, we may have, in 
addition, pain in the ovaries, great tenderness over the hypo- 
gastric region, and sometimes this tenderness extends over 
the entire abdomen. This is the case where there is present 



DYSMENORRHEA. 47 

peri-metritis. The poor patient can not sleep or eat. If food 
is taken into the stomach, it is generally rejected very soon. 
The headache accompanying these cases is very distressing. 
Pain in the back is also often a distressing symptom. Cold 
hands and feet, with great restlessness and an irritable tem- 
per, are generally symptoms in these cases. 

Dysmenorrhoea is peculiar to women who are sterile or 
unmarried, except in a very few instances, and in those ex- 
ceptional cases it is less severe than in the barren woman ; 
for after the uterus has contained a child or foetus of consid- 
erable size, it is more tolerant of the presence of the effused 
fluid, and the stricture produced in the neck of the uterus 
by flexions is not so tight. The nervous symptoms are more 
prominent in some cases than others, but are doubtless de- 
pendent upon the temperament of the patient, and are not to 
be considered as a separate or peculiar form of the disease, 
if I may so speak, for I consider dysmenorrhoea only a symp- 
tom of other difficulties causing these peculiar symptoms. 

Differential Diagnosis. 

The only troubles likely to be confounded with dys- 
menorrhoea are, threatened miscarriage and some cases of 
uterine polypi. The history of the case will generally show, 
that the menses have been suppressed for a time, wholly or 
in part, in cases of pregnancy. This suppression, however, 
may have been months before, and may have continued three 
or four months, and the flow become again established and 
appear regularly, though usually too profuse and long contin- 
ued, till the seventh or ninth month arrives from the time the 
suppression commenced, or, in other words, till complete ges- 
tation would have been accomplished had the foetus lived. 
But the history of the case shows that a partial detachment 
of the placenta had occurred early in the pregnancy, causing 
the death of the foetus, but that it was retained in the uterus 
till full term had arrived. 



48 EA TON ON DISEASES OF WOMEN 

Such cases may have a history of pain similar to that our 
patient is now suffering, at a few preceding menstrual periods; 
but we will note that it was not so, previous to the suppres- 
sion. Some uterine polypi cause much suffering at the men- 
strual period. These cases may be recognized by having had 
easy menstruations at some early period of their lives, gener- 
ally up to within two or three years, and by physical examin- 
ation we discover the presence of the polypi, and clear up the 
diagnosis. 

Etiology. 

It is probably a fact, that a less number of cases of dys- 
menorrhoea are cured than of most other ailments peculiar to 
women. This is accounted for, in my mind, from the fact 
that I have found the cause of this pain in menstruation to be 
flexions of the uterus, or stenosis, in many cases. They may 
be either ante- or retro-flexed ; either condition may cause the 
difficulty. This is explained in the fact that the flexion 
causes almost the closure of the cervical canal at the point 
where the flexion is most abrupt. There is generally a point 
in these cases of flexion where the canal turns almost at right 
angles. Flexion also tends to produce irritation, tenderness, 
and abnormal congestion at the menstrual period. I say 
abnormal, because a slight increase of the turgescence or vas- 
cularity of the endometrium is a normal condition at the 
menstrual epoch. 

But when this normal congestion is increased by previ- 
ouslv existing increased vascularity, we have, as a result, 
considerable thickening of the mucous membrane of the uter- 
ine canal, and this tends to obstruct more fully the cervical 
canal at the point where the flexion had nearly closed it. 
Consequently, when the body of the uterus becomes filled 
with menstrual flow, the uterus naturally takes on contractile 
action, and we have the intermittent pains of true dysmen- 
orrhoea. These contractile pains of the uterus that is flexed, 
tender, and congested, are very severe, and continue, till the 



DYSMENORRHEA. 49 

constriction is forced open, and the contents of the uterus is 
forced out. This consists often of clots (the retention of the 
effused blood having caused them to form), and their presence 
adds to the necessity for severe expulsive pains to force them 
out. So we may see that the process corresponds very nearly 
to that of ordinary miscarriage, and is often more severe. 
Again, in the membranous form, the cause of the pain we have, 
is the necessity of severe enough uterine contractions to rup- 
ture the membrane, and peel it off from the intra-uterine 
surface; this process is termed denidation, or nidation. The 
student will readily comprehend the cause of the severe pain 
previous to the discharge of any menstrual fluid in these pa- 
tients. In some cases the flow commences moderately, with 
little pain, and, after a day or so, the pain commences severely. 
These pains are produced by the contractions necessary to 
expel the membrane, the blood in the slight amount that has 
been already expelled having passed out between that portion 
of the membrane already detached and the intra-uterine 
surface. 

The investigations of Engelmann* show that this mem- 
brane is the upper layer of the proliferated mucous mem- 
brane in a state of fatty degeneration, that is exfoliated, and 
thereby a hemorrhage is occasioned ; hence we have more 
liability to the formation of clots in these cases than in nor- 
mal menstruation. This process is termed denidation by Dr. 
Aveling,f and he compares it to parturition, and terms the 
membrane thrown off the nidal decidua. 

Chronic ovaritis may be a cause of pain at this period, 
producing not only more sensitiveness in the organs, but from 
slow inflammatory action causing a thickening and tough- 
ening of their fibrous coat, and consequently more difficult 
ovulation. Or we may have a rheumatic condition of the 
general system, which may so affect the ovaries as to pro- 

*Strickler's "Med. Jabrb," page 135. 
tObstet. Jour, of Great Britain and Ireland, July, 1874. 

4 



50 EATON ON DISEASES OF WOMEN. 

duce painful menstruation; but I am inclined to the belief 
that in the great majority of cases displacements of the 
uterus, with some degree of endo-metritis and stenosis of the 
cervical canal, are the main causes of dysmenorrhea. 

Prognosis. 

This must depend much upon the willingness of the pa- 
tient to submit to proper treatment. As the patients usually 
feel tolerably well during the interval between the men- 
strual periods, they are very often disinclined to pursue the 
necessary treatment. In this case an unfavorable prognosis 
is the best we can make. But, in case we may have 
several months to treat the case, the prognosis may be favor- 
able. We are usually justified in prognosing sterility, if let 
alone, in cases that are severe; with proper treatment we 
may, in most cases, expect that pregnancy will be possible. 

Treatment. 

Whoever achieves success in the treatment of this diffi- 
culty, may feel that he is equal to the task of treating almost 
any of the diseases of women, for to be successful, the phy- 
sician must show power of careful discrimination in diag- 
nosis, decision of character and will, in proceeding to do that 
for the case which it seems to demand. Perseverance in 
treatment, proper encouragement to the patient (that he may 
have her full co-operation), is necessary. This is all impor- 
tant, as it is generally the case that the patient enjoys quite 
a good degree of health in the intervals between the men- 
strual periods, and it is absolutely necessary that the treat- 
ment be continued thoroughly during these intervals. Much 
care and judgment need to be exercised in the selection of 
the remedies, and in the surgical or mechanical treatment 
used. Hence I deem the skill demanded in these cases equals 
any that is required in any case of gynaecology. These cases 
are the more embarrassing on account of their being found 



DYSMENORRHEA. 51 

mostly in those women who have either never been married, 
or have never borne children, and hence are more averse to 
the making of the necessary vaginal examination, and are 
much more troublesome to treat, even if they consent to an 
examination. They are likely to be careless about regular 
calls upon the physician, and as this class of patients are 
usually desirous of concealing from the public," and some- 
times even from friends, the fact of their having any ailment 
whatever, they are very annoying, and, as I said before, 
require all the skill at any one's command to carry them to 
a successful issue. 

Remedies During: the Attack. 

When called to a case of severe dysmenorrhoea the in- 
tensity of the sufferings demands something that will at once 
relieve the pain and vomiting. For this purpose, perhaps 
the most efficient remedies are the inhalation of Sulph. Ether, 
or Chloroform, with warm foot and hip baths — of course, 
using the Ether or Chloroform after the patient has taken 
the bath, and is nicely wrapped in bed, as anaesthetics are 
never to be given to any one while in the erect or semi-erect 
posture. The hypodermic injection of pure water in the 
arm or limb will sometimes give instant relief, and is prefer- 
able to the use of Morphia in any manner. 

Sometimes Puis. 3 X gives relief; again, Secede 3 X , or Vi- 
burnum l x , will be most efficient. Secale or Viburnum being 
indicated for those pains that are entirely confined to the 
uterus, of an intermittent character, while Puis, is indicated 
in cases where the ovary is also largely affected. 

Cimicif. Rac. gives, usually almost instant relief to the 
ovarian pains and tenderness, which sometimes continue after 
the contractile pains of the womb have ceased, and the flow 
has been established. These remedies, as indicated, will re- 
lieve, giving Aconite, Ars., or Bell., according to their general 
indications so well understood, in these cases, which are clue, 



52 EATON ON DISEASES OF WOMEN. 

evidently, from their history, and all we can learn, to an acute 
congestion of the uterus, which sometimes occurs, and produces 
severe menstrual colic ; but they are not cases of true dys- 
menorrhea as generally understood, any more than a slight 
cold in the head is catarrh. Attacks of menstrual colic, 
from acute congestion, will be cured with these remedies, the 
same as such cases are cured where there is no menstrual 
colic, and we may expect little trouble with this class of 
cases. If the history of the patient shows the attack to be 
probably due to acute congestion, we may have no occasion 
to make a physical examination. The remedies I have indi- 
cated will cure the case promptly and efficiently. But the 
case whose history shows years of monthly suffering, will not 
be cured with these remedies; we must use other measures 
and remedies, or have a failure. 

If flexion of the uterus is the cause, we will only be 
able to detect it, in most cases, with the uterine sound. 
When discovered, of course, it is to be rectified as in other 
cases of flexions, but in these dysmenorrhoeal patients we 
have more trouble in introducing the sound, as here we will 
find a narrowing of the neck of the uterus at some point, 
generally at the internal os. Much patience may be neces- 
sary to accomplish the introduction of the sound, and, in some 
cases, it will be found impossible. The next thing to do, on 
failing to introduce the sound, is to introduce into the cervix 
uteri a sponge tent, and follow by another in about six hours, 
keeping the patient in bed. In introducing the tents press 
upon them for some minutes, that they may follow the 
crooked canal, and as they dilate expand the portion that 
is constricted, and enable us on the removal of the second 
tent, to introduce the sound into the body of the uterus, and 
detect the flexion, if one exists; and, if there be no flexion, 
and we find the uterus in situ, we will have prepared the 
uterus for further treatment in the way of curing the dis- 
ease of the internal surface of the organ that has caused the 



D YSMENORRHCEA. 53 

dysmenorrhea, by exfoliating the dysmenorrhoeal membrane, 
or obstructed the natural outlet of the body of the womb by 
the congested condition of the endometrium. This diseased 
condition of the endometrium is usually present and needs 
treatment in these cases, whether we have a flexion or not. 
Hence, it will be seen that I consider the use of tents to 
be very necessary in the treatment of most cases of true 
obstructive dysmenorrhoea. 

The incision of the neck of the uterus, as some recom- 
mend, is to my mind very objectionable, and as I have never 
found it necessary in over twenty years of practice in this 
line, during which time it has been my lot to treat very 
many cases, I feel that possibly incisions of the cervix uteri 
may be abandoned. Incisions, in order to be successful 
at all, must be followed by dilatation by some means ; if 
not by tents, then forcibly and abruptly, by means of in- 
struments. It seems our Creator has made the cervical 
canal in such a manner as to be expanded without danger, 
even to immense proportions, as seen in parturition. In 
abortion it also has to dilate, which it often does with but 
little pain. 

The sponge tent seems to me to act the most in confor- 
mity to the process nature has established ; that is, it causes 
gradual dilatation. Should we incise the neck of the uterus, 
and simply leave it to heal without any attempt at dilatation, 
the circumference of the canal will be lessened instead of 
increased ; its dilatability will be diminished on account of 
the cicatrix left. 

From the wounds made by incision we have danger of the 
absorption of pus or muco-purulent matter, which is abun- 
dant in some of these cases. Besides, I see nothing to be 
gained by incisions, and much greater danger is incurred than 
with the use of the sponge tent. 



54 EA TON ON DISEASES OF WOMEN. 

Subsequent Treatment. 

After a good degree of dilatation of the entire cervical 
canal is accomplished, I proceed to apply directly to the 
intra-uterine surface a Solution of Iodine, making it with five 
grs. Iod. Res., fifteen grs. Potass. lodid., to one oz. of water. 
This should be further diluted with Avater if it produces any 
considerable amount of smarting. This is conveniently ap- 
plied with Palmer's uterine applicator. These applications 
I repeat once in three days, keeping the cervix dilated by 
passing a large bougie daily through the cervical canal. 
Omit the treatment four or five days previous to the time for 
the commencement of the next menstrual period. Vaseline, 
or Bell, ointment, may be used through the applicator in 
some cases with advantage. 

Internal Medication. 

Probably there is no remedy so efficient as Phos., given 
in the 2 X or 3 X attenuation twice a day, and continuing the 
treatment for several months ; especially is this efficient in 
the membranous form of dysmenorrhoea. 

Prof. Carl Schroeder, of Bavaria, says : * " The fact that 
membranous dysmenorrhoea has been observed in poisoning 
by phosphorus, favors the view that a profound fatty degen- 
eration, even in a normal mucous membrane, may bring about 
the membranous exfoliation." 

Cat. carb.y Graf., Iod. of Merc., Phytolac., Cocculus, or 
Caidophyllum, etc., may sometimes be of much service, when 
used in accordance with the totality of the symptoms. 

Treatment of Rheumatic Dysmenorrhoea. 

In the rheumatic condition of the system we will do well 
to try the effect of Bry. or Rhus, Colch., Kali hyd., 
etc., according to the peculiarities of the case and the homoeo- 
pathic indications for their use. 

* Ziemssen's Cyclopaedia, "Diseases Female Sex. Organs," p. 335. 



DYSMENORRHEA. 55 

Besides giving Phos. in the membranous variety of dys- 
menorrhea, we must bear in mind that the exfoliation of 
membrane is the result of inflammatory action, and endeavor 
to rectify any cause producing this irritation, and treat the 
case very much the same as we would if purely a case of 
chronic endo-metritis. 

Remedies Occasionally Indicated. 

Bell., Coff., Cham., Coloc., Graph., Plat., Sulph., Ignat., 
Nux v. 

Belladonna is indicated in dysmenorrhoea with flushed 
face, dullness of the mind, fullness over the eyes, intolerance 
of light, pain in moving the eye-ball, feeling as if the contents 
of the pelvis would pass out of the vagina, severe bearing 
down in the pelvis, etc. 

Coff., where the flow is full but painful; loss of appetite, 
sleeplessness, nervousness, irritation of the bladder, etc. 

Cham., where there is colic in the bowels, as well as pain 
in the uterus ; discharge comes in clots, restlessness ; breasts 
are tender and swollen. 

Graphites, where there is chilliness, with dull headache, 
heartburn, constipation before, and diarrhoea after, the menses. 

Platina, where the ovaries are enlarged or tender, with 
extreme nervousness, depression of spirits, severe cutting, 
labor-like pains, dark-colored menstrual flow, etc. 

Sulphur. The catamenia are too profuse, with pain in 
the small of the back; at times the flow ceases, and again 
comes on profusely ; burning in the vagina, etc. 

Ignatia, where the menses are scanty and dark-colored ; 
the pain amounts almost to spasms ; palpitation of the heart, 
fain tn ess, etc. 

Nux Vomica. Severe pain in the back, constipation, 
want of appetite, cramping pains in the abdomen. 



56 EATON ON DISEASES OE WOMEN. 



CHAPTER VI. 



VIC A RIO US MEN ST R UA TION. 



By vicarious menstruation is meant the discharge of blood 
from some of the mucous surfaces other than the uterine, at 
somewhat regular intervals, accompanied with arrest of the 
normal catamenial flow. These hemorrhages sometimes take 
place from the nose, called epistaxis ; from the stomach, called 
hematemesis ; from the lungs, called hemoptysis ; or from the 
bowels, either with or without the presence of hemorrhoids. 
(Leucorrhoea, diarrhoea, etc., also sometimes seem to be vica- 
rious of menstruation.) 

These discharges seem to relieve the system, so that the 
patient suffers much less than she otherwise would from the 
suppression of menstruation. These hemorrhages, of course, 
occur at other times and from other causes, and are only con- 
sidered vicarious menstruation when occurring in connection 
with suppression of the regular flow. When coming on from 
other difficulties or diseases, they are ordinarily to be ar- 
rested, while in the case troubled with suppression they are 
rather to be encouraged (within reasonable limits), and viewed 
as conducive to health rather than disease. The patient is 
often greatly alarmed at these hemorrhages, until they are 
explained to her. 

These discharges greatly relieve the hypersemic condition 
of the circulation induced by the retention in the system of 
the material usually cast off at the menstrual flow; and, 
if not relieved in some way, would soon manifest the more 
dangerous symptoms of congestion of the brain, lungs, stom- 
ach, pelvic organs, or bowels. Frequently, in these cases, 
the uterus appears torpid, showing no increase in size, no 



VI CAR 10 US MENSTR UA TION. 57 

heat or congestion, showing that the fault lies in the normal 
periodical nerve excitement in these parts, which invites the 
excited circulation of the blood to them. In other cases, the 
congestion, heat, and enlargement of the uterus is marked, 
showing that there is a normal excitement of the circulation ; 
but the flow is absent through some abnormal condition of the 
endometrium, generally that of thickening, by exudation of a 
plastic material on its inner surface, causing the obstruction 
of the flow, from its close adhesion to the interior surface 
of the uterine mucous membrane. This condition is not of 
very infrequent occurrence, as a result of mild inflammatory 
action, as shown by the throwing off of stringy, semi-organ- 
ized, membranous material, from cases affected with a mild 
endo-metritis not always being highly enough organized, or 
not adherent enough, to prevent the menstrual flow, but 
peeling off and being discharged at the flow and during the 
interval. This, of course, might as well be explained under 
the head of Amenorrhoea. In some cases an indolent ulcer 
on the leg or other part of the body seems to act as a vica- 
rious menstruation, so that the patient is relieved from con- 
gestive symptoms resulting ordinarily from suppression. Why 
it is that in one case the discharge takes place in one patient 
from the lungs, in another from the stomach, bowels, or nose, 
we can not explain, unless it be that these membranes are, in 
the particular patient, in a condition of slight irritation, and 
the blood oozes through the minute capillaries more readily, 
on this account, in this particular locality. 

Vicarious menstruation has been known to take place from 
the skin, gums, nipples, etc.* (See Edinburgh Med. Journal, 
1866; London Lancet, 1872; and Transactions Med. Society 
Bombay, 1872.) These instances are, however, of extreme 
rarity, and are only worthy of remark on account of their 
possible occurrence in the practice of any physician. 

* Barnes on "Diseases of Women," p. 182. 



58 EATON ON DISEASES OF WOMEN. 

Treatment. 

As stated before, the discharge of blood vicariously of 
menstruation is a relief to the system if within moderation, 
still it may be so profuse as to constitute a hemorrhage, and 
be dangerous to life if not restrained. Continual conges- 
tions and effusions of blood, occurring in those membranes 
not normally so affected, may develop serious ulceration, 
and it becomes the physician's duty to carefully diagnosticate 
between the discharge which is vicarious, and that which is 
pathognomonic of disease in the part or organ from which it 
is effused. 

In the case of the vicarious discharge it is advisable to 
first establish the normal function before doing more than to 
restrain the discharge within the bounds of moderation. 
This treatment may be found under the head of treatment 
of amenorrhoea, and consists of remedies and means to invite 
the circulation and nerve force to the generative organs. 
This is accomplished with Puis., Canth., Macrotis, etc., the 
use of warm foot and hip baths, electricity passed through 
the pelvis, or directly through the uterus, by means of the 
uterine electrode, exercise on horseback, etc. 

But there are cases where menstruation is arrested from 
causes somewhat out of the ordinary line, like atresia of the 
cervix, the presence of large intra-mural fibroids, pregnancy, 
etc. Atresia of the cervix will, of course, be discovered in an 
attempt to pass the uterine electrode, which must not be done, 
however, if there is a possibility of pregnancy. The condi- 
tion of pregnancy sometimes develops vicarious menstruation ; 
but not often. It is well to be on the alert to recognize this 
condition, as active interference would be likely to induce an 
abortion. We may, however, seek to equalize the circulation 
of the blood by warmth to the extremities, and using some 
effort to restrain the hemorrhages by giving Aconite or 
Ipecac. I am aware that these cases are not recognized by 



VICARIOUS MENSTRUATION. 59 

some gynaecologists as vicarious menstruation, on account of 
the pregnancy present. 

If the flow was from the uterine surface or cervix, and 
occurred regularly each month, it would be menstruation, 
though pregnancy did exist at the same time, and I see no 
impropriety in calling a flow from other mucous surfaces vica- 
rious menstruation, if it occurs at regular intervals, although 
pregnancy exists. The treatment must be modified, how- 
ever, as has been suggested. Some cases of this kind may 
be so difficult of diagnosis as to baffle, for a time, the most 
skilled physician, owing to the peculiarities in the particular 
case ; still, the more thoroughly the subject is studied, the less 
likely will the physician be to fall into errors in treatment. 

Atresia of the cervical canal, of course, demands an oper- 
ation ; stenosis requires dilatation. These conditions, as well 
as those where uterine fibroids are present, must be treated 
as will be stated under these special heads. 

Remedies indicated in amenorrhea are usually demanded in 
these cases. (See Chapter III.) 

The remedies must act to stimulate strength and activity 
in the ovaries and uterus in atonic conditions, and to allay 
irritation when these organs are inflamed. 



60 EATON ON DISEASES OF WOMEN. 



CHAPTER VII. 

INFLAMMATION OF FEMALE GENITALIA. 
Etiology. 

The female genital organs are probably more subject to 
inflammation than other parts of the body. This is owing 
to various causes, some of which I will mention. The most 
prominent one that suggests itself is cold. The open cloth- 
ing so commonly worn by women offers little protection 
to the pelvic organs from severe changes of temperature. 
Especially is cold injurious at or about the menstrual period. 
The ovaries, uterus, and vagina are at this period congested, 
so to speak, though the function of menstruation is a physio- 
logical one, and one that is necessary to the health of the 
female. Still we may speak of the congestion of the parts 
occurring at this period, and generally a few days previously. 

This congestion especially affects the mucous membrane 
lining the uterine cavity. Cold baths, taken by girls and 
ladies while menstruating, have often caused inflammation of 
the uterine organs. I have seen the inflammation of so high 
a grade from these causes as to endanger life. I have seen 
it also produce paraplegia, hemiplegia, as well as hysterical 
convulsions. 

Sexual Intercourse, which is resorted to by the lower 
animals solely for the purpose of reproduction, except in one 
or two species, is resorted to by man as the most common 
indulgence of his nature, and is frequently the cause of 
inflammation of the uterus, and, from the irritation and 
excitement produced, causes also the effects of cold to be 
more severely felt. 

The reading of lascivious books, the nature of the asso- 



INFLAMMATION OF FEMALE GENITALLA. 61 

ciations of many of the amusements of society, constipation 
which is due to not attending to the evacuation of the bowels 
at proper intervals, tend to produce inflammation of the 
uterus. This is particularly the case with teachers and schol- 
ars, who delay the calls of nature for a more convenient op- 
portunity ; and they soon lose the inclination to evacuate the 
bowels, and the retention of the fecal matter causes the hard, 
constipated stool, requiring straining in its expulsion, produc- 
ing hemorrhoids, and general congestion of blood in all the 
pelvic viscera. Constant standing, distress of mind, self- 
abuse, falls, jolts, heavy lifting, careless management after 
abortions, or confinement at term, lacerations of the cervix 
uteri, etc., all tend to produce inflammation. It is a fact to 
be borne in mind that causes which might produce severe in- 
flammation in one, might not affect another ; but this is also 
true throughout the whole range of physical ailments affecting 
mankind. Hence, because one woman, or possibly a class of 
women, may not receive injury from a particular cause, it 
does not disprove the possibility of others being affected 
seriously by it. 

There is much in the constitution of women, as well as 
men, to withstand or predispose to disease. The girl of ro- 
bust parentage, brought up to active exercise suitable for her 
years and strength, using suitable food and clothing, till 
she is twenty years of age, will ordinarily endure five times 
the fatigue that one could endure reared under opposite 
circumstances, and having parentage broken in health and 
constitution. 

Symptoms. 

The term inflammation indicates heat, or burning, in itself, 
and the term is used in medicine to indicate a high tempera- 
ture, tenderness, generally swelling of a part, tissue, or organ. 
This is true of acute inflammation, and is as applicable to in- 
flammation of the female genital organs as to any other part 
of the body, and no more so. 



62 EA TON ON DISEASES OF WOMEN. 

But we have a sub-acute form of inflammation affecting 
these organs more frequently than other parts of the body, 
and these sub-acute forms are characterized by a train of 
symptoms quite different from those produced by acute in- 
flammation. We will, for convenience, make the following 
divisions of inflammation as effecting the female genitalia : 

1. Acute Inflammation. 

2. Sub-acute Inflammation. 

3. Chronic Acute Inflammation. 

4. Chronic Sub-acute Inflammation. 

Acute Inflammation. — This sometimes commences with a 
distin.ct rigor or chill; but this is not always well marked, 
and in some instances entirely absent. This cold stage varies 
in duration from an hour or two to ten or twelve hours, when 
reaction comes on, and Ave have increase of heat, much thirst, 
dryness of skin, and general symptoms of fever. So far the 
symptoms might be present in any inflammatory attack, pre- 
ceded by some congestion, in any part of the body; and even 
in the various forms of intermittent fever we have a similar 
array of symptoms as we have in the outset of an attack of 
acute inflammation of the genital organs in the female. After 
the lapse of about twenty-four hours we have additional 
symptoms that characterize this disease, which are not pres- 
ent in ordinary fevers, or in congestive or inflammatory at- 
tacks of other parts of the system. These are pain, heat, and 
tenderness of the vagina and uterus, and, in some cases, fre- 
quent desire to urinate, accompanied with pain in the urethra 
of a burning character. If the ovaries are affected, we will 
have tenderness, with some swelling, of these organs. These 
urgent, active symptoms are present in cases of acute inflam- 
mation of any, or all of the genito-urinnry organs, and are 
present, I may suggest, also, when the inflammation is caused 
by specific poison (i. e., gonorrhoea!) ; but, in the acute in- 
flammation of the gonorrhoea! case, these symptoms may be 
three days or more from the time the first intimations are 



ACUTE INFLAMMATION. 63 

noted till the full development of the inflammation, when we 
have also the symptoms of a copious yellowish white dis- 
charge from the vagina, with great swelling of the labia 
majora and minora. But I will not enter more into detail in 
the matter of gonorrhoeal inflammation, as its importance 
merits an entire chapter, and I prefer to give a full descrip- 
tion of the disease under the proper heading, where it will 
be found in connection with the homoeopathic treatment for 
its cure. 

In the acute inflammation caused from colds, exposure, 
and, I may mention, sometimes the suppression of eruptions 
on the skin, we have active symptoms, as I have described, 
and they point to this disease unerringly. There is no chance 
to be misled. Soon, in addition to the symptoms of heat, 
pain, tenderness, swelling, etc., just enumerated as affecting 
the labia, vagina, uterus, ovaries, etc., we have, within two 
or three days, a profuse discharge, generally acrid in its 
character, light yellow, or milky, and in no way to be recog- 
nized by its appearance from the discharge produced from 
gonorrhoeal inflammation. There is no way at the present 
day, so far as I know, to determine by its appearance whether 
or not the vaginal discharge in such cases is gonorrhoeal or 
not. We have to note other symptoms than the discharge, to 
make up a diagnosis. Of course, gonorrhoeal discharge some- 
times follows impure connection, and, did we know of this 
exposure, we might be the more read}' to call the disease 
gonorrhoeal. But let the physician be cautious; much trouble 
might result to him and others by giving such an opinion. 

The non-specific inflammation comes on, ordinarily, much 
more suddenly than the specific; but the symptom of painful 
micturition is not very prominent unless the disease affects 
the bladder mainly ; in which case we have none of the ten- 
derness, heat, and pain in the vagina, nor much of the vaginal 
discharge just mentioned as occurring when the vagina has 
been inflamed for any length of time. Hence, this case would 



64 EATON ON DISEASES OF WOMEN. 

be diagnosed as cystitis, and not as acute inflammation of the 
geni to-urinary organs. We will also have nausea present, in 
many instances, produced by sympathy with this acute in- 
flammation of the pelvic organs in the female. 

Treatment. 

The treatment of acute inflammation (non-specific) should, 
in the first instance, be rest for the entire body, warmth to 
the extremities, a warm full bath, or sitz bath, for ten or 
fifteen minutes, and when taken from the bath the patient 
should be rubbed dry, and well wrapped in warm blankets; 
and repeat these baths once a day as long as the urgent, 
active symptoms show themselves. 

The first remedy to be given, and I may say the last also, 
in many cases, is Aconite nap. This remedy alone usually 
controls all these symptoms, and will ordinarily carry the case 
through to a favorable termination, unaided by other reme- 
dies. We will very often find this remedy to cut short every 
symptom, and restore to a state of health almost as if by 
magic, stopping the disease before any discharge has made its 
appearance. If w 7 e were so fortunate as to be called in the 
first stage, or rather when we had congestion present, cold- 
ness, etc., I would prefer Gelseminum or Arsenicum alb., the 
Ars. being indicated if nausea and vomiting, with thirst, were 
prominent symptoms, otherwise give Gelseminum. When the 
second stage is established give Aconite. After the acute 
stage is passed and we have not succeeded in curing the 
case, and it passes into a chronic, active inflammation, or a 
chronic sub-acute form, I would use other remedies, which we 
will designate under the treatment for those conditions. 

Sub- acute Inflammation. — The term sub-acute inflamma- 
tion indicates a grade of inflammatory action that is more 
mild in its symptoms than acute inflammation. The sub- 
acute form of inflammation may come on so insidiously as 
to be scarcely noticed until the disease is thoroughly estab- 



SUB- ACUTE INFLAMMATION. 65 

lished and the patient is much broken down in health, and 
perhaps consults the physician on account of this general 
debility, or under the impression that the difficulty is some- 
thing entirely different from what is really the matter. 

Etiology. 

The causes of this disease are somewhat similar to those 
which produce active inflammation, but owing to the good 
constitution of the patient, or the small amount of exposure 
a very acute inflammation is avoided, and in its stead a 
sub-acute form is established. The sub-acute form is often 
caused also by the use of cold vaginal injections to prevent 
conception, and by acid injections for the same purpose. Fre- 
quent child-bearing is also a fruitful cause of this sub-acute 
form; neglect of cleanliness, as well as too frequent bathing, 
may produce the disease. The wearing of hard vaginal pes- 
saries, as well as rough, brutal copulation by the husband, or 
promiscuous sexual intercourse, sub-involution of the uterus, 
and lacerations of the cervix uteri in confinement, also tend 
to cause this disease. 

Symptoms. 

The symptoms of sub-acute inflammation may not mani- 
fest themselves in the parts affected to any great extent, 
and in some instances there may be no symptoms that point 
directly to the difficulty, unless we are aware of the fact that 
the symptoms indicating sub-acute inflammation are generally 
in some part of the body somewhat remote from the pelvis, 
and are caused by reflex nerve action. True, we may some- 
times have slight tenderness of the vagina or os uteri, or 
slight tenderness in the ovarian region; but often we have 
no tenderness. Sometimes we have a slight vaginal dis- 
charge and sometimes none. On making a physical exami- 
nation we find the vagina warmer or colder than natural. 
The secretion instead of being oily and slippery to the 
feel is often tenacious, and the odor of the vaginal secretion 



66 EA TON ON DISEASES OF WOMEN. 

is nauseous. The os uteri is found enlarged, the length of 
the uterus, as found by introducing the uterine sound, indi- 
cates considerable increase of size, sometimes measuring, 
from os to fundus, four or four and a half inches. Some 
tenderness is found to be present in some cases, and in rare 
instances a complete hyperesthesia of the parts is caused 
from sub-acute inflammation. Still in these cases of ncute 
sensibility, we have absent those general symptoms of ex- 
treme heat, swelling, and general fever we have in the acute 
form. Sometimes we have hot flashes, as the patient de- 
scribes them. 

The symptoms that we may expect the patient to com- 
plain of in sub-acute inflammation of the genital organs in 
the female are backache, pain in small of back, sometimes 
at the extremity of the coccyx, pain under the left breast, 
palpitation of the heart, various dyspeptic symptoms, tym- 
panites, etc.; with pain in the occiput, heat in top of head, sci- 
atic pains, general lassitude, weakness of the limbs, sometimes 
a feeling of weight in the pelvis, sometimes not. It will be 
appreciated that these symptoms, though more moderate in 
their action, are nevertheless wearing on the patient, and 
though the disease might kill slowly, it might kill just as 
surely as the more active form of inflammation. 

This sub-acute form of inflammation, when affecting the 
ovaries or uterus, is one of the most prominent causes of 
tumors in these organs. Generally we have sterility as 
another symptom of this disease, and it will probably con- 
tinue till the disease is cured ; and possibly barrenness may 
result, and remain after all other evidences of disease have 
disappeared. 

Treatment. 

Aconite, so useful in the acute form of inflammation, is of 
little use in the sub-acute; here we need Br?/., Bell., Ars., 

Ars. iod., Merc, iod., Rhus, Ignatia, Nux, Puis., Sepia, etc. 
These should be selected according to the homoeopathic indi- 



CHRONIC ACUTE INFLAMMATION. 67 

cations in each particular case. (Consult works on Materia 
Medica.) 

As to local applications, I will say, my experience justi- 
fies the use of some local treatment; but not such as has 
been in use by all gynaecologists of the old school, and, I 
blush to say, some of our own. I refer to nitrate of silver, 
nitric acid, strong chromic acid, tincture of iodine, leeches, 
etc., ad infinitum. We discard all these, in treatment of these 
diseases. I sometimes, however, apply the Solution of Iodine 
locally to the os externum and internum, and even to the 
intrauterine surface. This solution is to be prepared with 
water and the addition of Kali iodatum in the proportion 
of three grs. of the latter to one of the former. I usually 
use the strength of about three or five grs. to the ounce, ap- 
plied with a camel's-hair pencil every three days. Some 
cases of sub-acute inflammation of uterus and vagina are 
greatly benefited by the ball of cotton (to which is attached a 
string for its easy removal), saturated with equal parts of Tr. 
Hydrastis and Glycerine, placed in the vagina, well up against 
the os uteri. It may be noticed that I am not entering into the 
description of the special inflammations or their treatment, 
this chapter being intended as general in its application to de- 
scription and treatment. A more minute description of the 
treatment of special inflammations of particular parts may be 
found under the chapters on Vaginitis, Metritis, Ovaritis, etc. \ 

Warm Water. — The warm water vaginal injection and 
warm sitz bath are quite generally useful, and, I believe, can 
in no instance do harm in any form of pelvic inflammation, 
when used properly. 

Chronic Acute Inflammation. — There are some cases of 
inflammation of the pelvic organs that go on actively for a 
considerable time, having a tendency to progress to the extent 
of the formation of an abscess or ulceration, in spite of the 
most active measures we may use to subdue them. The allo- 
pathic profession have tried the antiphlogistic treatment, have 



68 EA TON ON DISEASES OF WOMEN. 

bled and leeched, physicked, and given remedies the most 
powerful in depressing the activity of the circulation; and still 
active inflammation has continued till abscess resulted. The 
homoeopathic treatment of active inflammation has not al- 
ways been successful, though much more frequently so than 
the allopathic. Hence, we have a class of cases to which 
it seems to me appropriate to apply the term chronic-acute 
inflammation. 

Symptoms. 

The exact time at which an acute inflammation becomes 
chronic, we are not able to specif}' in hours or days. The 
symptoms will be a better guide to the proper nomenclature 
to be applied than the expiration of any particular length of 
time. I am inclined to draw the line at such time as the 
general symptoms of fever, general heat, and extreme rapid- 
ity of the pulse subside in part, and, if it be a week or so 
after the onset of the active symptoms, and still we have the 
tenderness and heat of the pelvic organs remaining, the 
vagina tender to the touch, the labia swollen, tenderness of 
abdomen in hypogastric or iliac regions, the patient, unrelieved 
hy proper medication, continuing to present these symptoms 
with depressed general strength, pulse weak, though often as 
high as 100 to 120 per minute, temperature indicating from 
101° to 103°, tongue generally coated light brown or brownish 
white, with red tip and edges, papillae elongated, we denomi- 
nate the case chronic-acute inflammation. Following on in the 
progress of the disease, we have, in the next stage, those 
symptoms that are indicative of the formation of pus; such 
as slight rigors, throbbing sensation in the pelvis, some in- 
crease of heat, etc. On vaginal examination, we may feel fluc- 
tuation, usually in the posterior portion of the vagina, the os 
tender and swollen, the heat of vagina much above the natural 
temperature, generally accompanied with a copious mucopuru- 
lent discharge from the vagina. The patient complains of 
great pain at stool; the most careful manipulation causes great 



CHRONIC ACUTE INFLAMMATION. 69 

suffering. We do not wish to be understood as saying that all 
cases of chronic-acute inflammation always result in abscess ; 
but we say that there is a great tendency to the formation of 
abscess. We also have a class of cases which may be consid- 
ered chronic in that they are subject to frequent attacks of 
active pelvic inflammation, they being really cases of sub-acute 
inflammation, that, owing to cold or exposure of some kind, 
has caused the acute for a time to supplant the sub-acute, 
then under treatment; ordinarily, by the natural restorative 
powers of nature, active inflammation subsides, and leaves the 
sub-acute form in its stead, there being enough irritation re- 
maining to attract towards the parts all the impurity of the 
blood, retard and retain all the degenerated blood corpuscles, 
thereby aiding in the development of malignant disease, or, 
perchance, only hypertrophy or areolar hyperplasia of the 
uterus. The most frequent seat of abscess, when it does form 
from general pelvic, chronic, acute, or active inflammation, is 
in the cellular tissue, generally posterior to the vagina and 
uterus. I can only account for this from the fact that the 
position of the patient on the back, with the thighs semi-flexed 
on the abdomen, which is the position usually voluntarily as- 
sumed by the patient in acute pelvic inflammation, allows the 
uterus, with weight of bladder and its contents, to press more 
heavily against the cellular tissue posterior to these organs, 
and tends to retard more fully the circulation there, and, of 
course, on this account, gives greater tendency to the forma- 
tion of abscess in this locality than in the anterior or lateral 
portions of the pelvis. Abscess forming anterior to the uterus, 
between it and the bladder, is usually caused from circum- 
scribed inflammation in this particular location, induced by 
anteversions of the ,womb, direct injury, peri-metritis, etc. 

Treatment. 

We must not allow the bowels to become charged with 
fecal matter, and thus press upon the inflamed tissues. The 



70 EA TON ON DISEASES OE WOMEN. 

most suitable means to prevent this is the regular daily use 
of warm water enemse, with plenty of soap dissolved in the 
water. Never let the solicitations of the patient or friends 
induce you to allow the administration of purgative medicines. 
The increased peristaltic action of the bowels that they would 
occasion would be more injurious than to allow the bowels to 
remain inactive. Still there is no need of their remaining 
overloaded, and it is better to insist on their being moved 
with enemse than to neglect them. Warm vaginal injections 
of castile-soap and water, used several times a day, with warm 
fomentations with hop-bags applied to the perinseum and over 
the hypogastrium, are to be used, with warmth to feet and 
sustaining diet of beef-tea, egg-nog, and the like. Milk will 
be well borne and easily digested, if to it is added a small 
quantity of salt. Let this hint be ever remembered. Milk 
often disagrees with the stomach of patients because of too 
much acidity there ; but if we correct this acidity with a little 
lime-water or a little salt added to the milk, we chemically 
overcome the acidity, and our diet of milk is very acceptable 
and satisfactory. Should all means fail of accomplishing reso- 
lution of the inflammation and absorption of the matter, we 
may have to evacuate the abscess. This is much better prac- 
tice than to allow it to go on to spontaneous evacuation, as it 
may form an opening in an inconvenient locality, and, besides, 
be much more difficult to heal than when evacuated artificially. 
As to methods of operating, we refer the reader to the chapter 
on Cellulitis, where he will also find some general directions 
as to the after treatment of the abscess. 

The remedies most frequently indicated are Bell., Merc., 
Hyos., Bry., China, Sepia, Cimicif., Can. ind., and Hamamelis, 
internally and externally. 

Chronic Sub-acute Inflammation — Description. — We find 
in practice that there are cases where there is present a sub- 
acute inflammation, not only of the cervix uteri, but also of the 
endometrium, the ovaries, bladder, vagina, and cellular tissue 



CHRONIC SUB-ACUTE INFLAMMATION. 71 

surrounding the pelvic organs as well, often implicating the 
peritoneal covering, so that it may he considered, as a whole, 
under the name of chronic sub-acute, pelvic inflammation. 
The patients in these cases may be able to go about their 
usual avocations a considerable part of the time, though suf- 
fering much pain. This pain is in the organs themselves, 
and also in the back, loins, thighs, occiput, top of the head, 
and under the left breast. Digestion is generally impaired, 
much flatus in the stomach and bowels is generally pres- 
ent; and palpitation of the heart and fainting spells are 
frequently symptoms of this difficulty. 

Etiology. 

The cause is often obscure. These cases generally come 
under our care with a history often so long that we need to 
make a special appointment of an hour to hear it, and, when 
we learn it all, we generally find that the array of treatment, 
and the names of different physicians who have from time 
time treated the case, will occupy no small part of the 
recital; and as several years have generally elapsed since the 
patient has been a sufferer, we often find it extremely diffi- 
cult to decide what was the cause of her trouble in the first 
instance. Sometimes it is clear that a miscarriage, or con- 
finement badly managed, was a prime cause, in other cases 
that a cold taken and neglected at the menstrual period 
seems to have laid the foundation for the long train of suf- 
ferings that the patient has endured. Again, injudicious 
treatment, especially with pessaries, caustics, frequent cold 
baths, the continuous use of cathartics, etc., seem to have 
kept up the irritation. Again, unsatisfied sexual passion, 
as in the case of those ladies who have married men many 
years their senior (whose sexual vigor was inadequate to 
satisfy the wife, though sufficient to excite her) ; entire 
continence, in cases of the unmarried, at ages ranging from 
thirty to thirty-five years, has seemed to me to tend to pro- 



72 EATON ON DISEASES OF WOMEN. 

cluce this condition. My experience would lead me to believe 
that the two latter classes of ladies are rather more subject 
to this difficulty than any other. This condition may be, in 
some instances, caused by uterine displacements and the 
accompanying ovarian displacements, producing irritation of 
the organs themselves and the surrounding parts as well. 

Diagnosis. 

In these cases it is not hard to see that the patient is 
ill, as the constitutional disturbance generally present will 
clearly indicate it; and, did we fail to see at a glance that 
something was the matter, the patient will not long allow 
us to remain in ignorance that she is a great sufferer. 
Doubtless these patients have much real suffering, but the 
gravity of the prognosis should not be measured by the 
extent of the patients' complaints, as we Avould be led to 
believe from them that dissolution was imminent. They do 
not always, however, refer their sufferings to the part dis- 
eased, but often to the stomach, back, or head, and fre- 
quently to the liver, which does become torpid in some in- 
stances, it is true, by reason of the depressed nerve strength 
of the system, tending to torpidity of the glandular system 
in general, thereby producing a condition of imperfect secre- 
tion and excretion. This tends to emaciation, and to pro- 
duce that swarthy, yellowish color of the skin we so often 
see in this class of cases. The long train of symptoms pro- 
duced from dyspepsia — the depression of mind, the unrest, 
the dissatisfied disposition — will lead us to be on the alert to 
investigate the condition of the pelvic organs. The exami- 
nation will disclose similar symptoms as in case of sub-acute 
inflammation; and these, conjoined with the grave constitu- 
tional symptoms just mentioned, together with the great 
length of time the patient has been in ill health, will give us 
reason to diagnose the ailment, chronic sub-acute inflam- 
mation. We will generally find hypertrophy of the uterus in 



CHRONIC SUB-ACUTE INFLAMMATION. 73 

these cases, though occasionally in the. patient of fifty years 
of age and upwards — sometimes in those of thirty-five or 
forty years of age, who have remained virgins — we have an 
atrophied condition of the organ; but in the case of atrophy 
we generally have increased sensibility, amounting to great 
tenderness. The ovaries are usually enlarged and tender, 
sometimes only one is affected; if so, it is generally the left. 
There is a sense of weight and bearing down in the pelvis 
while in the erect posture. The chronic yellowish leucor- 
rhoea, often acrid, is frequently a persistent symptom. Pain in 
the small of the back or in the sacroiliac articulation, sciatic 
pains, burning in palms of hands and soles of the feet, heat in 
the top of the head, palpitation of the heart (though the rhythm 
remains normal, and no abnormal sounds are to be observed 
by stethoscopic examination), tenderness in epigastric region, 
coated tongue, loss of appetite, restless sleep, bad dreams, 
etc., are symptoms we find in most cases. Chronic constipa- 
tion is almost always present; spasmodic stricture of oesopha- 
gus, and the globus hystericus, are often complained of. Para- 
plegia, of almost any part of the body, may result from this 
disease. The menstrual function is usually deranged in those 
ladies who have not passed the climacteric period. Some- 
times we find scanty and sometimes profuse menstruation, 
sometimes too frequent and sometimes delayed menstruation. 
The sympathetic symptoms are almost endless, and when 
we find a lot of obscure symptoms in a patient, who has also 
a considerable number of the symptoms just enumerated, we 
are generally right in supposing they are caused from this 
chronic sub-acute inflammation of the pelvic organs. Mu- 
cous polypi, hydatids, and, in fact, all the forms of polypi, 
as well as fibroids of the uterus, ovarian fibroids, and 
fibro-cysts and vaginal cysts, are caused largely, in my opin- 
ion, from this condition of chronic sub -acute inflamma- 
tion. Acute inflammation may attack a case previously suf- 



74 EATON ON DISEASES OF WOMEN. 

fering from chronic sub -acute inflammation, and the sub- 
acute is often left after the subsidence of the acute form. 

Treatment. 

First, I will recommend in these cases, as of the utmost 
importance, some form of abdominal supporter, to lift and hold 
up the abdominal organs, so that they do not press upon the 
irritated pelvic organs. I can not be too emphatic upon this 
point. Without the aid of the abdominal supporter, I would 
not expect to be successful in curing these cases, and, with 
its use, we have trouble enough. I generally use my Improved 
London Abdominal Supporter (see plate No. 12), or one made of 
silk and elastic; but every physician should use judgment and 
ingenuity in adapting the support to each individual case. T 
think no set rules need be laid down, except to use a support 
that is efficient, and at the same time comfortable to the 
patient. 

Where we have severe peri-metritis in the case, we may 
have to enjoin perfect rest in the recumbent posture, till we get 
this condition somewhat relieved by remedies ; but very long- 
continued decubitus is objectionable, in that it tends to debil- 
ity, and seriously interferes with the process of digestion. 
It is better, therefore, to hold up the abdominal organs with 
suitable support, and not only permit, but enjoin, exercise of 
a moderate character. 

I am so impressed with the necessity of exercise, and at 
the same time keeping the tender parts from suffering irrita- 
tion from the superincumbent weight of the abdominal 
organs, that I prefer the abdominal supporter to all the reme- 
dies that can be given in the treatment of this disease. 
Doubtless remedies are beneficial, and do cure, when we have 
suitable conditions and accessories. The frequent use of the 
tepid, salt water, hip bath is very beneficial. Let the patient 
sit in the bath ten or fifteen minutes, twice a day. Sponge 



CUR ONIC SUB- AC U TE INFLAMMA TION. 75 

off the hips well with alcohol and water, equal parts, after 
each bath. The following preparation of watery Solution of 
Iodine may be applied freely over the os every two or three 
days, and also to the intra-uterine surface in obstinate cases. 
If it becomes necessary to apply it to the endometrium, it 
will be generally necessary to dilate the cervical canal with a 
sponge tent or two, and then use a soft brush or the uter- 
ine applicator to apply it. 

1^. — Iodine, res., grs. v. 

Potass., iodide, grs. xv. 

Aqua, 3 1 "I- 

Et. sig. Solution Iodine. 

This solution can be further diluted with water to any 
extent desired. We can not do this with the Tr. of Iodine. 
When much water is added to the Tr., the solid Iodine is 
deposited and becomes a caustic. The dilution of Tr. Iodine 
with alcohol is objectionable, in that the alcohol smarts too 
much. The use of Tr. Iodine to the os uteri, or "applied 
to the intra-uterine surface, is not desirable because of its 
caustic properties. The usefulness of the solution of Iodine. 
as I recommend, is to promote absorption of the serous infil- 
tration in the tissues, which is so commonly present, and to 
allay the unhealthy action we call by the name of chronic 
sub-acute inflammation. The daily use of this remedy is not 
beneficial. It would be like the administration of the prop- 
erly selected homoeopathic remedy in too low an attenuation. 
It might aggravate the difficulty. The introduction of this 
solution directly into the substance of the uterus or ovaries, 
in cases of enlargement that resist all other measures, is 
useful and to be recommended. This is accomplished with a 
large syringe with a long, stout tube. (See syringe for inject- 
ing uterine fibroids.) This may be repeated once in three or 
four days for two weeks, when it is best to wait two or three 
weeks and watch results. There is, perhaps, no one remedy 
that exerts so beneficial an effect upon this disease as Phy- 



76 EA TON ON DISEASES OF WOMEN. 

tolac. dec., in the l x or 2 X attenuation, given every three or 
four hours. 

China, Ars. tod., Bry., Nux, Sepia, Cimicifuga, Bell., Cal. 
carb., Ignatia, Cantharis, Hepar sidph., Cham., etc., are 
the remedies to select from in each particular case, as the 
totality of the symptoms seem to indicate. If we have uter- 
ine hemorrhage, or absence of menstruation, polypi, cysts, 
or tumors, we must treat them on the principles laid down 
under these diseases, which will be treated of specifically 
under their proper heads. Attention to the administration of 
suitable diet, that is nourishing and still easy of digestion, is 
always to be remembered. Cheerful company, change of 
scene and climate, will sometimes aid materially ; and, if the 
patient has lived in a malarious district, we must recollect 
how much this tends to lower the strength of the nervous 
system, and produce a condition of chronic congestion, and 
apply our remedies accordingly. 



METRITIS. 77 



CHAPTER VIII. 



METRITIS. 



The term metritis signifies inflammation of the uterus as 
a whole, including its muscular tissue, serous covering, lining 
membrane, and sub-mucous and cellular tissues. In a case of 
metritis we have, then, peri-metritis, endo-metritis, and cer- 
vicitis combined. There is generally sympathetic inflamma- 
tion of the ovaries and broad ligaments in a case of metritis. 
The inflammation may extend to nil the pelvic and some of 
the abdominal viscera, or it may remain confined to the 
uterus. When the pelvic cellular tissue is invaded by inflam- 
mation, the disease is called cellulitis, which may also com- 
plicate a case of metritis. 

Generally, we have an active inflammation to contend 
with in these cases, which will require skill and firmness in 
treatment, though the diagnosis is easy. The disease in its 
acute form runs a rapid course, either to destruction of the 
patient or ends in restored health within a few weeks, and 
sometimes in a few days. When the disease extends to the 
abdominal organs, the case is grave. Puerperal metritis I will 
not discuss at this time, as a separate chapter is required for 
its full explanation. It being best discussed in connection 
with puerperal peritonitis, and having so much in it depend- 
ent upon the condition of the lying-in state, I prefer to speak 
of it separately. I will, however, include in this chapter in- 
flammation of the uterus following abortion, which is some- 
what allied to puerperal peritonitis, with much less of involu- 
tion requisite in the uterus, but, at the same time, perhaps the 
more dangerous of the two. The fatality in metritis following 



78 EATON ON DISEASES OF WOMEN. 

abortion I will explain in this chapter, as it is more like 
the cause which produces mortality in ordinary metritis. 

Diagnosis. 

The diagnosis of metritis, as I mentioned before, is not 
difficult. The patient complains of great pain and heat in 
the uterus. There is soreness and tenderness of the entire 
organ. Generally, the acute attack commences with a chill, 
or at least chilly sensations, followed by a fever, often of a 
high type ; generally some nausea, and, in some instances, 
frequent vomiting. The fever continues, or intermits for a 
short time, and returns as severely as ever; the pulse is 
fine and wiry; tongue generally coated white, sometimes 
white or brown coat in center of tongue and red around the 
edges; enlarged papillae here and there project through the 
coating of the tongue, and are extremely red; considerable 
headache and backache is complained of; constipation is 
common, though diarrhoea is sometimes present. There is 
little or no tenderness of the vagina in the recent uncompli- 
cated case, but it feels hot to the touch, and the uterus is 
found hot, swollen, and tender. Pressure made just above 
the pubis causes much pain. As the disease progresses the 
tenderness extends over the lower abdomen, showing peri- 
toneal complication. In this case (peri-metritis) gentle pres- 
sure over the hypogastrium produces pain. It is to be dis- 
tinguished from enteritis in that we require deep pressure to 
produce pain in the latter disease. 

There is a, profuse discharge of matter, mingled with 
streaks of blood, in the severe form of this disease, after it 
has lasted a few days. The introduction of the uterine sound, 
and sometimes even digital examination, produces a free flow 
of pure blood, even if gentleness is used in the examination, 
owing to the extremely congested condition of the lining 
membrane of the uterus, and also that portion of the vaginal 
membrane reflected over the neck in the vagina. 



METRITIS. 79 

The sub-acute chronic form of metritis I will speak of 
as areolar hyperplasia of the uterus. Strictly, any inflamma- 
tion of the uterus is metritis ; but special names are given to 
the disease when only a portion of the uterus is affected. 
Some writers divide metritis into two forms. — that which 
affects the cervix mainly, terming it cervical metritis; and 
that which affects the fundus, giving to it the name of me- 
tritis. In chronic cervical metritis we have a mild inflamma- 
tion of the sub-mucous tissue, which first tends to effusion in 
this tissue of a fibro-plastic material, which organizes after a 
time, to produce the indurations of the os found in these 
cases, if of long duration. To what extent the muscular 
tissue is involved in chronic metritis we are unable to say, 
but probably very slightly; and we have no evidence, in 
most cases, that the peritoneal coat is much affected, except 
in cases of the acute form of this disease. 

In metritis of an acute character there is usually con- 
siderable tympanites; but this does not distinguish it from 
inflammation of either of the internal female genital organs, 
or of the cellular or peritoneal tissues, as this symptom is 
common to all of them, both in their acute and chronic forms. 
Acute metritis may result in hypertrophy, softening, or gan- 
grene of the organ, but usually, under homoeopathic treatment, 
terminates in resolution. 

Etiology. 

Acute metritis results from cold taken at the menstrual 
period, first causing arrest of the flow, secondarily, inflam- 
mation; or it may attack a lady who has had some operation 
performed upon her for the removal of a, uterine polypus 
or has had the sponge tent used without having taken suit- 
able care of herself; or it may be caused from hard work 
and some exposure while very warm ; or it may result from 
excessive coitus, or cold vaginal injections, or the use of in- 
struments to prevent conception or produce abortion ; or su- 



80 EA 7' ON ON DISEASES OF WOMEN. 

pervene on a chronic endo-metritis or endo-cervicitis; or it 
may follow an abortion, from want of care, and rising too soon, 
with exposure to cold ; or from a retained placenta, or a part 
of one ; or a cold taken at this time ; or from lacerations of 
the cervix uteri in labor. 

After a miscarriage or premature labor, women are liable 
to be very careless, as they imagine little care is necessary. 
This want of care and caution tends to produce the acute 
attack of metritis. The re trover ted state of the organ pre- 
disposes to inflammation, especially the chronic variety; retro- 
version or retroflexion sometimes exists in girls, caused from 
jumping or a severe lift, and as puberty comes on the uterus 
becomes unduly congested, and an inflammatory condition is 
set up. This gives rise to severe suffering at the menstrual 
period, and is often a cause of the non-appearance of the 
flow, although monthly pains come on with regularity, and 
the general health is much affected. Constant standing, as 
in case of clerks and teachers, is frequently a cause of the 
sub-acute inflammation, which readily becomes acute and act- 
ive from taking a, cold, as this class of women are likely to 
do from exposure in all kinds of weather. 

Treatment of Acute Metritis. 

The first requisite in treatment is perfect rest in the 
recumbent position. If there is any peritonseal complication, 
placing the knees and thighs in a semi-flexed position gives 
some relief. The warm sitz bath, warmth to the feet, warm 
wet compresses over the hypogastrium, are all beneficial. 
Aconite should be given till the pulse is under control, be- 
comes soft, and the general fever subsides ; after which Bell., 
Bry. : Sepia, or Sidph. are frequently indicated. Injections of 
Hydrate of Cloral into the vagina are useful in soothing the 
irritation, tenderness, and pain. Do not be tempted into 
giving allopathic doses of Morphia or Opium \ though they 
give temporary relief, they derange the action of the stomach 



METRITIS. 81 

and bowels, arrest healthy secretion, benumb the system, and 
prevent the proper action of other remedies. 

The same remarks apply with equal force to the hypo- 
dermic use of Morphia. Its use has become shamefully 
frequent with some practitioners, and should be discounte- 
nanced, because we can relieve our patients in a short time 
without it; and because it so seriously interferes with the 
natural process of digestion and assimilation; and, worst 
of all, establishes in many the opium habit. The alarming 
increase of the habit of opium-eating in this country should 
cause us to be active in suppressing it, and careful not to aid 
in its spread. The import duties on opium paid the United 
States government for the year ending June 30, 1877, 
were $1,778,347. This gives some idea of the great amount 
of the drug consumed by opium-eaters in the United States. 

Cool lemonade is a means of great relief to the fever, 
and is much relished by most patients. Cold water may be 
drank with freedom in small quantities, often repeated. The 
diet should be very plain, consisting of gruel of corn or oat- 
meal, toast, with a little milk. The entire surface of the 
body should be frequently sponged with tepid water. Ca- 
thartic medicine must be positively forbidden, and tepid 
soap and water enemae used to move the bowels, in case of 
want of action in them. I speak of this, not that I expect 
any homoeopathic physician will prescribe a cathartic in these 
cases, but knowing that we sometimes have patients who 
have previously had allopathic treatment, and that they may 
take a cathartic without asking the physician's advice. 

From the swollen condition of the uterus and its pressure 
against the rectum in these cases, as well as some degree of 
irritation of the bowel from the spread of the active inflam- 
mation in the uterus, the patient feels a constant ineffectual 
desire to evacuate the bowels, which tempts her and her 
friends to use a cathartic. Hence, I make the su^estion to 
the student to forbid them, unless he knows his patient well 

6 



82 EATON ON DISEASES OF WOMEN. 

enough to be sure she will not take them unknown to him. 
The enema of water will unload the rectum if any fecal 
matter is lodged there ; and, besides, it serves to soothe the 
irritation in the bowel, while the cathartic increases the irri- 
tation, and may change a mild case into one of great severity. 

Remedies. 

In addition to Aconite, Bryonia, Bell., Sulph., and Sepia, 
already mentioned, Verat. alb., Verat. viride, Ignatia, Hyos., 
Puis., China, etc., will be sometimes indicated. (See works 
on Materia Medica for indications.) 

Treatment of Chronic Metritis. 

The student is requested to read the treatment of endo- 
metritis, as being largely applicable to cases of chronic 
metritis, excepting some complications more likely to arise 
in metritis than in endo-metritis. (Also, see Areolar Hyper- 
plasia of the Uterus.) 

Complications in Metritis. — In metritis we are liable to 
have some inflammation of the bladder as a complication. 
This is due, in some cases, to the pressure of the womb upon 
the bladder, from its increase of size, and sometimes to a par- 
tial ante-flexion or retro-version of the organ. In other cases, 
a continuation of the inflammation from the peritoneal cov- 
ering of the uterus to that covering the bladder, and thence 
to the muscular, and even the mucous, lining. This gives 
rise to a desire for frequent micturition ; in fact, we may 
have all the symptoms of cystitis, including a great amount 
of mucous discharge, which adheres to the bottom of the 
vessel with great tenacity. I know of no better remedies 
for this condition than Can. ind., Cantharides, Uva Ursi, 
Aeon., Bell., or Cubebs. 

Tendency to Dropsy. — In some cases we have a tendency 
to dropsy ; but it is generally manifested as ascites. This 
is produced from the peritoneal irritation causing an effu- 



COMPLICATIONS IN METRITIS. 83 

sion of serum into its cavity in excess of what is normal. 
The student will understand that, in the healthy condition 
of the peritonaeum, a small amount of serum is thrown out in 
its interior to lubricate it, and we may readily see how an 
irritation of the membrane may cause an excess of this secre- 
tion; and this accumulation of fluid in the cavity of the abdo- 
men is termed ascites. 

Ars., Merc, iod., Digitalis, China, Apoc?/niim, etc., are the 
remedies to be studied for this complication. 

Cellulitis as a Complication. — General pelvic cellulitis 
may complicate these cases ; for the treatment of which see 
chapter on Cellulitis. 

General Effects of Chronic Metritis. — It is readily un- 
derstood how the increased weight and size of the uterus 
would tend to produce displacements of the organ. In con- 
nection with displacements we would have, not only the 
reflex symptoms in ordinary displacements, but they are 
likely to be intensified, from the fact of having the irritable 
condition of* the organ, produced by the sub-acute inflamma- 
tion, in addition to the ordinary nervous effect in displace- 
ments. Hence, we are more likely to have hysterical spasms, 
a greater amount of brain symptoms, more derangement of 
digestion, etc., than in ordinary recent displacements without 
metritis. 

The Eyes are sometimes affected, so as to produce various 
forms of amaurosis, and sometimes much inflammation, as a 
result of these conditions of the uterus. The oculist needs 
to be thoroughly conversant with these facts, as otherwise his 
treatment would be calculated to give, at best, only tempo- 
rary relief. 

Sterility, Abortion, Etc. — Sterility is a common result, 
though in rare instances, where the irritation is slight in the 
endometrium, pregnancy may take place ; but as the uterus 
enlarges in pregnancy, it is liable to contract (owing to- its 
irritable condition), and expel the foetus prematurely. 



8£ EATON ON DISEASES OF WOMEN. 

Copulation Injurious. — Copulation should be interdicted 
in these cases, as it can hardly be otherwise than harmful by 
producing greater irritation, temporarily at least ; and as con- 
ception is likely to be followed by abortion, it is better it 
should not occur till a year or so after the patient appears 
well ; otherwise Ave may have a relapse. 

Tumors. — Metritis tends largely to the growth of tumors 
of the uterus, especially fibroids and fibrous polypi. It also 
tends to the development of cancer of the organ. 

Menstrual Derangements. — We also have menstrual de- 
rangements in metritis. More frequently than otherwise the 
flow is increased in duration, quantity, and frequency. This 
drain upon the system, in connection with the excessive leu- 
corrhoeal discharge and the pains she has to endure, with the 
poor nourishment she gets by reason of the disordered stom- 
ach generally present in these cases, tends to seriously exhaust 
the patient to an extent which may threaten her life. 

The development in the uterine cavity of vegetations of 
the endometrium, hydatids, or polypi, or granulations of the 
cervix, may cause this hemorrhage ; and it may be best to 
at once insert the sponge tent, dilate quite fully the cervix, 
and ascertain what the trouble is, if possible, in chronic cases, 
where uterine hemorrhage is present. The tent will tempo- 
rarily arrest the flow, and aid us in finding out what the real 
trouble is in the case. 

Remedies in Metritis. 

Remedies necessarily take a wide range in cases of me- 
tritis, on account of the various conditions present and the 
various constitutions of women. We have mentioned a few 
remedies in connection with the treatment, and will add some 
few indications for remedies in a more compact form. 

Aconite. — Fever, wiry pulse, dry skin; nausea; great 
tenderness of uterus, fear, restlessness, and despondency. 



METRITIS. 85 

Bell. — Dull, heavy headache; tenderness; pain in fore- 
head just over the eyes. 

Bry. — Stitches, cutting pain, fever, pulmonary compli- 
cations. 

Cal. Carb. — Light complexion, with profuse leucorrhoea; 
general irritation of the mucous membranes ; scrofulous pa- 
tients, with leuco-phlegmatic temperament, cold feet, vertigo, 
fear of impending evil, supra-orbital neuralgia, sour taste in 
the mouth, involuntary emissions of urine, bearing-down pain 
in the uterus ; especially useful with fleshy people. 

Ferrum. — Menorrhagia in women with red face; great 
weakness ; menses stop and return again. 

Gelsem. — Hysterical symptoms; hyperesthesia of a part 
of the body; tendency to hemiplegia ; confusion of the mind; 
sleeplessness; hysterical spasm; fever without thirst; the 
fever intermits; great nervous exhaustion. 

Graphites. — Profuse leucorrhoea, coming in gushes ; in 
ladies inclined to obesity, affections of the ovaries, severe 
bearing-down pain, constipation, the leucorrhoeal discharge is 
tenacious, excessive sensitiveness to cold, etc. 

Ig'iiatia. — Uterine cramps and stitches ; chlorosis ; much 
pain in rectum; excessive flatulency; incontinence of urine; 
restlessness ; changeable mood ; hysterical manifestations ; 
excessive yawning. 

Borax. — White, thick leucorrhoea; menses too profuse 
and too frequent. 

Cimicif . Rac. — Chorea ; great pain in the uterus or ova- 
ries; tendency to rheumatism; has hysterical tendencies; 
rheumatic or neuralgic pains in the uterus. 

Caiilopliyllum. — Insomnia; paraplegia; atony, and re- 
laxed condition of the uterus; hysterical spasms; irregular 
menstruation ; excessive uterine hemorrhage. 

Carbo. Veg*. — Great weakness; tympanites ; cardialgia: 
eructations of glairy mucus ; acrid leucorrhoea ; heat, redness, 
itching of the labia and vulva ; voluptuous thoughts. 



86 EATON ON DISEASES OF WOMEN. 

Conium Mac. — Swelling of the breasts ; stitches in the 
breast, mostly at night; induration of the cervix uteri, with 
sharp pain in the part; acrid leucorrhoea; prolapsus uteri. 

Colocyiithis. — Flatus ; rolling pain in the bowels ; agon- 
izing pain in the bowels; blood flows from anus; urine is 
thick, foetid, scant; restlessness, with great anxiety; sci- 
atic pains. 

Verat. Viritle. — Congestive state of the pelvic organs; 
tenderness of the uterus; fever; heat; restlessness; palpita- 
tion of the heart; local or general hyperesthesia. 

Verat. Alb. — Hyppocratic countenance ; excessive sexual 
passion; tendency to diarrhoea; despair; hysterical or puer- 
peral convulsions ; fretful disposition ; nervous headache. 

Patiiiuin. — Depression of spirits ; excessive sexual de- 
sire ; excessive uterine hemorrhage ; much bearing down pain 
in pelvis ; ovarian tenderness ; indurations of the uterus ; 
albuminous leucorrhoea; useful in hysteria. 

Rhus Tox. — Numbness of feet and limbs;, rheumatic 
complications ; takes cold easily ; white sediment in urine ; 
uterine hemorrhage. 

Secale Cor. — Bearing down pain in uterus ; uterine hem- 
orrhage; has cold perspiration; flabby condition of the mus- 
cles; menses profuse; relaxation of the uterine tissues. 



AREOLAR HYPERPLASIA OF THE UTERUS. 87 



CHAPTER IX. 

AREOLAR HYPERPLASIA OF THE UTERUS; OR, CHRONIC PAREN- 
CHYMATOUS METRITIS. 

Areolar hyperplasia of the uterus has been, until of late, 
described as chronic metritis. Professor Thomas, of New 
York, has taken great pains to elaborate this disease in his 
work on "Diseases of Women," fourth edition. I shall take 
the liberty to quote considerably, at length, from him, as his 
views regarding this disease are so fully in accord with my 
own, I feel that in all respects, save a part of his treatment, 
I can fully agree with him; the objectionable points (in my 
mind) in his treatment being scarifications and blisters locally 
to the cervix uteri, and his drug medication, which is, how- 
ever, in accord with the school of medicine to which he 
belongs, and is, I believe, as good as any which has been 
proposed by any one of that school. I am convinced of the 
more satisfactory results of homoeopathic drug medication, 
and one of the best wishes I could ask for man, as well as 
woman kind, would be that the old school might, in a body, 
embrace and practice the principles of homoeopathy. As 
I turn to Professor Emmet's new work on "Diseases of 
Women" to learn what he says upon this disease, I am sur- 
prised to find he has omitted it entirely, and find, on further 
search, that he has said but a few words upon hypertrophy 
of the uterus, and nothing under the heads of either metritis 
or chronic parenchymatous metritis, though his Avork is so 
very elaborate and excellent in many respects. I had pre- 
viously noticed that in his index I could find no mention 
made of puerperal fever, puerperal phlebitis, mammary ab- 
scess, hydatids, hysteralgia, cervicitis, rectocele, sterility, etc., 



88 EATON ON DISEASES OF WOMEN 

still I was unprepared to find that he gave but a page or so 
to the consideration of all the forms of inflammation of 
the womb. 

Inflammation of the uterus, in its various forms, we have 
considered of the utmost importance, and we have attempted 
to describe and give the treatment of metritis, endo-metritis, 
cervicitis, endo-cervicitis, and peri-metritis, and still we could 
not feel our work complete, or up with the onward progress of 
medical discovery, without giving some time to the consider- 
ation of areolar hyperplasia of the uterus. This is rather a 
result of disease than a disease per se. The connective or 
cellular tissue, situated between the endometrium and mus- 
cular tissue, between this muscular tissue and the outer cov- 
erings of the uterus, and also connecting the fibers of the 
muscular tissue of the organ, is the part affected in this dis- 
ease, which results as a consequence of long continued irritation 
of some part or the whole of the organ. In the outset the 
disease of the uterus may have been endo-metritis, cervicitis, 
or even endo-cervicitis only, and still the connective tissue 
may have become, after a time, affected so as to produce 
hyperplasia of this tissue. 

The condition is similar to that found in cases of chronic 
cervicitis. There is engorgement of the cellular tissue, from 
effusion of serous fluid into its interspaces. 

This effusion, resulting from chronic irritation, may some 
day be discovered to contain material which is not always so 
mild in its effects as serum; and I suspect that herein may 
be found, at no distant day, an explanation of the develop- 
ment of carcinoma of the uterus. 

In hypertrophy of the uterus all the tissues of the organ 
are enlarged, especially its muscular tissue. In areolar hyper- 
plasia the muscular tissue may be atrophied instead of en- 
larged, although the organ as a whole is enlarged, owing to 
the distension of the connective tissue from the effusion 
mentioned. 



AREOLAR HYPERPLASIA OF THE UTERUS. 89 

This effusion in time becomes organized, forming new 
areolar tissue, or distending the minute cells of this tissue so 
as to appear increased in its substance. Following this con- 
dition, further effusion may take place into this tissue of 
sero-plastic lymph, or of abnormal cell plasma, which may 
cause induration, or cancerous degeneration of the tissues ; or 
the hyperplasia may remain (for a long period at least) without 
resulting in induration or carcinoma. In these cases the uterus 
is found enlarged, somewhat patulous, often displaced, espe- 
cially downwards, and often retro-verted or flexed. Constipa- 
tion is an almost constant symptom in these cases, vesical 
irritation, strangury, ischuria, etc., being frequent; pain in the 
loins, back, or thighs, pain at the base of the brain, or on 
the top of the head, gastric derangements, nervous or hyster- 
ical manifestations, etc. This is the train of symptoms point- 
ing to this condition, especially when the history of the case 
shows that these symptoms have been present for a long time. 
Pain in the pelvis is not very frequently complained of in 
these cases, and the absence of this pelvic pain is the very 
point likely to mislead the physician in diagnosis. The symp- 
toms are largely sympathetic, and embrace, at one time or 
another, about all the sympathetic effects manifested by any 
uterine disease. (See Sympathetic Affections.) Of this dis- 
ease Dr. Thomas * says : 

" One of the most common pathological combinations which 
confront the gynaecologist is that which I here endeavor, in 
as concise a manner as possible, to picture. A patient calls 
upon us for relief of backache ; pelvic pains ; dragging sen- 
sation about the loins; 'bearing down pains;' leucorrhcea; 
menstrual disorder, tending chiefly to excessive flow; throb- 
bing sensation about the uterus ; general feeling of despond- 
ency, malaise, and weakness ; and irritability about the blad- 
der and rectum. All these rational signs pointing to the 
uterus as the probably delinquent organ, a physical explora- 

*Thomas's "Diseases of Women," p. 274. 



90 EA TON ON DISEASES OF WOMEN. 

tion is made, and furnishes the following results : The uterus 
is usually discovered to be in the condition of descent, retro- 
version, or ante-version; it is voluminous, tender to the touch, 
and evidently engorged with blood; from the cervical canal 
a leucorrhoeal matter pours; the probe carried to the fundus 
finds it tender, and creates the flow of a little blood; the 
cervix is often in a condition of granular or cystic degenera- 
tion; and a low grade of vaginitis exists. 

"To this pathological combination the more superficial 
diagnostician will often apply a name which announces one 
only of the existing conditions ; as, for example, uterine ca- 
tarrh, ulceration of the cervix, or retroversion or prolapse. 
The more reflective and intelligent examiner will ordinarily 
group the coincident morbid states together under the name 
of ■ chronic metritis.' 

"The latter would be fully sustained in his position by 
authority as abundant as it is orthodox, for by systematic 
writers, since the days of Recamier, this uterine state has 
been described as one of ' chronic parenchymatous metritis.' 
Only within a very recent period have the pathologists of 
the German school begun to question the validity of this 
conclusion, which, taking its origin in France, was spread 
through England and America chiefly by the writings of Dr. 
Henry Bennet. According to this view, the following patho- 
logical changes were believed to be those resulting in the 
condition just described. In the first stage the parenchyma 
was regarded as gorged with blood, a state of active conges- 
tion existing. This was supposed soon to pass into the sec- 
ond stage, consisting in an effusion of lymph, when, unlike a 
similar process in other parts, the morbid action ceased, or 
rather did not advance, and, unless relieved by treatment, 
continued stationary for a length of time. The third stage 
of inflammation in other parts, that of suppuration, was ad- 
mitted to occur rarely here, or in the parenchyma of the 
body, but in time, all inflammatory action ceasing, the cervix 



AREOLAR HYPERPLASIA OF THE UTERUS. 91 

remained large and indurated without sensitiveness, or the 
effused lymph might be absorbed, and great diminution in 
size occur with induration. Were this really the case the 
condition would constitute one of inflammation, even if we 
restricted ourselves in the use of that ambiguous term to the 
narrow and precise limits prescribed by Dr. J. Hughes Ben- 
nett, when he says : ' It should be applied only to that per- 
verted alteration of the vascular tissues which produces an 
exudation of the liquor sanguinis; it is this exudation alone 
which can be held to unequivocally characterize an in- 
flammation.' 

'•Examined more recently, however, by the more certain 
and less theoretical processes of modern science, all this has 
come to be looked upon as erroneous. Cases which were 
formerly regarded as instances of inflammation — on account of 
the existence of enlargement, congestion, and tenderness upon 
pressure — the microscope now proves to have been instances 
of excessive growth of the connective tissue of the uterus, 
with congestion, and resulting hyperesthesia of its nerves, 

i; It may result from three entirely different pathological 
states : first, from interference with retrograde metamorphosis 
of the puerperal uterus from any cause ; second, from conges- 
tion long kept up by mechanical causes, such as displace- 
ment; third, from a formative irritation or state of hyper- 
nutrition excited by endo-metritis, or the existence of fibrous 
tumors. Whatever be the originating pathological condition, 
that which results and which we are now considering con- 
sists in hyperplasia of connective tissue as its most marked 
feature, and of congestion and nervous hyperesthesia as im- 
portant accompaniments. 

" Every-where throughout the recent and progressive lit- 
erature of gynecology the foreshadowing of the advancing 
change in views with regard to this subject will be recog- 
nized. The pendulum, swung too far by the hand of Dr. 
Henry Bennet, is making its inevitable return. That it may 



92 EA TON ON DISEASES OF WOMEN. 

stop on safe middle ground must be the hope of all. 'The 
determination of blood to a part here noticed, characterized 
by dilatation of the arteries, with increased flow of blood 
through the capillaries, must be distinguished from the con- 
gestion of inflammation, characterized by the accumulation 
and stagnation of red and white corpuscles in the vessels, 
tending to be abnormally adherent to each other and to the 
vessels,' says Dr. H. G. Wright,* quoting from Dr. Aitken. 
' Tested by this standard ' (that of Dr. J. Hughes Bennett, 
already quoted), says Dr. Graily Hewitt,f 'the uterus is cer- 
tainly very little liable to "inflammation;" exudation, and 
transformation of such exudations, purulent and otherwise, 
similar to what may be witnessed in other organs of the 
body, being very rarely witnessed in the parenchyma of the 
uterus. The morbid processes with which we are familiar 
as affecting the tissues of the uterus are, for the most part, 
alterations of growth, irregularities in growth, slight modifi- 
cations, in fact, of the processes which follow each other in 
due succession in the natural condition of things. The word 
"inflammation," used in Dr. J. Hughes Bennett's sense of 
the word, certainly fails to convey an adequate idea of the 
modifications observed under such circumstances.' 'Diffuse 
growth of connective tissue,' says Klob,J 'constitutes the 
so-called induration, hitherto considered as a result of par- 
enchymatous inflammation of the uterus. . . . For rea- 
sons mentioned I would also advise a disuse of the term 
"chronic inflammation.'" In a discussion || upon chronic 
metritis, before the New York Academy of Medicine, Dr. 
Noeggerath limited the disease to 'growth of cellular tissue, 
both of the body and neck, occurring only during the puer- 
peral state.' Dr. Peaslee preferred 'to call the disease under 
consideration congestion, rather than inflammation, because 
it has none of the events of inflammation;' and Dr. Kam- 

* " Uterine Disorders," p. 218. t " Dis. of Women," p. 363. 

t a Op. cit.," p. 129. II " Med. Record," No. 92, p. 475. 



AREOLAR HYPERPLASIA OF THE UTERUS. 93 

merer expressed the view that 'chronic inflammation of the 
substance of the non-puerperal uterus is never met with ; 
what has been described as such is hypertrophy of connec- 
tive tissue, resulting from long continued hypersemia.' 

" These views, which, among men who are in the advance 
in gynaecology, are rapidly gaining ground, are not sustained 
by analogical reasoning, but by anatomical proof. I know 
of nothing which will more surely convince the reader of the 
necessity for an alteration in our nomenclature concerning 
this condition than a perusal of Scanzoni's* article upon it. 
This author, after heading his chapter 'Chronic Parenchy- 
matous Inflammation of the Womb,' goes on to say : ' The 
nature of the disease would then be, in an anatomical point 
of view, a hypertrophy of the cellular tissue.' Certainly 
the 'anatomical point of view' is an important one, and it is 
supported by what we observe from a clinical stand-point. 

" So much evil has arisen for pathology and treatment 
from the use of the term chronic metritis, and so clear a 
demonstration has been made that the condition so called is 
not one of true inflammation, that some other appellation 
is not only desirable, but has become absolutely essential. 
It is incontestable that there is a peculiar condition that 
affects the uterus which is characterized by distention of 
blood-vessels from vital or mechanical cause, effusion of 
the serum of the blood, and hypergenesis of connective tis- 
sue. To denote this state, gynaecologists have long required 
a name, for medical nomenclature is as necessary as it is 
faulty. Lisfranc felt this need when he styled it 'engorge- 
ment ;' Hodge, when he entitled it ' irritable uterus ;' Bennet, 
when he called it 'metritis;' and others have also acknowl- 
edged the necessity; Klob, for example, in 'habitual hyper- 
aeinia' and 'diffuse proliferation of connective tissue;' and 
Kiwisch, in 'infarctus.' 

" The appellations infarctus, engorgement, and hyperaemia 

*" Diseases of Females," Aui. ed., p. 181. 



94 EATON ON DISEASES OF WOMEN. 

only convey a partial idea of the truth; they only announce 
one element of the condition — congestion — while that of 
irritable uterus ignores all structural change in announcing 
another element — nervous hyperesthesia. At the same time 
that the phrase, ' diffuse proliferation of connective tissue, 
due to hyperemia/ which is employed by Klob, clearly de- 
fines the pathological condition, it is too long and burdensome 
to answer the purpose of a name to be conventionally em- 
ployed. If there be a term now in existence which does 
really convey the idea truly and completely, it should surely, 
in the interests of pathology and treatment, as well as out 
of consideration for the overburdened student of medical 
nomenclature, be employed in preference to the adoption of 
a new one. Enlargement of an organ, due to the formation 
of new cells similar to those of the tissue in which they are 
developed, has been styled, by Yirchow, hyperplasia, in con- 
tradistinction to hypertrophy, which consists in increase of 
size from distension of cells already existing. As the con- 
dition of the uterus now under consideration is one arising 
from over-excitation of the vaso-motor and excito-nutritive 
nerves, a ( formative irritation,' as Klob styles it, and result- 
ing in a numerical hypertrophy, it appears to me that the 
term areolar hyperplasia would more correctly designate it 
than any other with which I am acquainted. With a sincere 
desire to lessen, and not to increase, the labors of the stu- 
dent and the perplexities of the gynaecologist, I shall, there- 
fore, replace the confusing term, chronic metritis, by that of 
areolar hyperplasia of the uterus. 

" If the disease really consists in a proliferation or hyper- 
trophy of the areolar or connective tissue of the uterus, and 
not in chronic inflammation, it would certainly be advan- 
tageous to apply to it some name which would signify that 
fact. 'Areolar hyperplasia'* expresses this fact concisely, 

* Hypertrophy signifies excessive growth of the elements of a tissue already 
existing; hyperplasia signifies the development of new tissue. 



AREOLAR HYPERPLASIA OF THE UTERUS. 95 

and hence I have employed it. But the only proof of the 
appropriateness of a newly applied term is its general adop- 
tion. If this be accepted, I shall feel that good has resulted 
from my effort; if its approval be not implied by adoption, 
I shall admit, with regret, that I have only helped to render 
confusion worse confounded. 

"Pathology of Areolar Hyperplasia. — The vast majority 
of cases are due to interference with that retrograde meta- 
morphosis occurring in the puerperal uterus, styled involu- 
tion. To comprehend the pathology of cases thus arising, it 
will be necessary to consider the physiology of that process 
as well as the pathological conditions which may affect it. 

"It is only within the last quarter of a century that we 
have understood the process by which the uterus, an organ 
measuring three inches, in the short space of nine months 
enlarges so as to contain a child, or even two or three chil- 
dren, and then, within two months after delivery, undergoes 
so rapid an absorption as to return to its original size. The 
credit of elucidating the subject belongs chiefly to Germany, 
for it is to Virchow, Franz Kilian, Heschl, Kolliker, and 
Retzius that Ave are most indebted. 

"The important pathological fact, that arrest in a disturb- 
ance of this process constitutes a condition of disease, ema- 
nated from Sir James Simpson, who, in 1852, published the 
first article which drew especial/attention to it. His article 
was entitled, 'Morbid Deficiency and Morbid Excess in the 
Involution of the Uterus after Delivery.' Since that time, the 
condition which now engages us has become generally recog- 
nized as a uterine state of great frequency and moment. 

"To fully comprehend this part of our subject, it is nec- 
essary to bear in mind the component parts of the healthy 
uterine parenchyma. It consists of five elements : 1. Fusi- 
form fiber cells, or, as they are termed, the smooth muscu- 
lar fibers; 2. Round and oval nuclei, which are supposed to 
be elementary fusiform fiber cells; 3. Amorphous or homo- 



96 RATON ON DISEASES OF WOMEN. 

geneous connective tissue, which permeates the parenchyma 
and binds together the fiber cells and nuclei; 4. Fibrillated 
connective tissue or white fibrous tissue; and, 5. Elastic 
fibrous tissue. These elements, together with nerves, blood- 
vessels, and lymphatics, make up the tissue of the uterus, 
which is covered by a serous membrane externally and a 
mucous membrane within. 

"No sooner does this structure feel the stimulus of con- 
ception than it develops rapidly, partly by growth of already 
existing structures, and partly by new formations. The 
round or oval nuclei rapidly develop into fusiform cells, and 
these as rapidly grow into colossal cells, which grow longer 
and more powerful as pregnancy advances. 'A new forma- 
tion of muscular fiber also takes place,'* the connective tissue 
elements grow proportionately, and the blood-vessels enlarge. 

"Parturition occurs, and almost immediately a retrograde 
evolution begins to restore the uterus to its original constit- 
uency. The fully developed fibers undergo a fatty degener- 
ation; the fat thus formed is absorbed, and the organ rapidly 
diminishes in size and weight. This fatty degeneration affects 
the organ after the fourth day subsequent to delivery, and, 
according to Heschl, the commencement of a new formation 
of muscular fibers is recognized in the fourth week after 
labor, in the form of nuclei and caudate cells. At the end 
of the eighth week the uterus has returned to its nor- 
mal state. 

" Certain untoward influences may retard or check this 
process, and the uterus remain flabby and large, when it is 
said to be in a state of sub-involution, or arrested retrograde 
evolution. 

" Thus far we have been dealing with facts thoroughly 
ascertained by histological investigations and fully established 
by evidence yielded by the microscope. But from this point 
the pathology of sub-involution is not so satisfactorily settled. 

* Arthur Farre: "Cyc. Anat. and Phys.," Article Uterus. 



AREOLAR HYPERPLASIA OF THE UTERUS. 97 

Prof. Simpson declared that the disease was due to the fact 
that 'this retrograde metamorphosis of the uterus has not 
taken place during the puerperal month, or has taken place 
only to such an imperfect degree that the uterus is of the 
size we usually see it have at the end of the first week or 
so after delivery;' but he entered, if I may judge from the 
posthumous volume of his work upon Diseases of Women, 
upon no detailed account of the existing pathological defect 
in the organ. Since his writing, it appears to have been 
agreed upon that this consists of persistence of the muscular 
fibers, characterizing pregnancy, in a state of fatty degener- 
ation. Thus Dr. Wright * says : ' Pathologically, it closely 
corresponds with that state of the heart structure so admir- 
ably described by Dr. Richard Quain, and commonly known 
as fatty degeneration.' Dr. Westf expresses himself thus: 
1 Though fatty degeneration of the tissues takes place, yet 
the removal of the useless material is but imperfectly accom- 
plished, while the elements of the new uterus are themselves, 
as soon as produced, subjected to the same alteration.' I 
search in vain the literature of the pathology of this subject 
for a basis for these hypotheses. That literature is scanty in 
the extreme as yet, and the subject awaits extended re- 
searches before we can speak intelligently of it. The day 
has passed, however, when we can let probabilities in pathol- 
ogy pass current for facts. 

" The best, indeed I may say the only, detailed account 
of this condition studied by the microscope, which I have 
been able to obtain, is one by Dr. Snow Beck,J of London. 
' The enlargement of the uterus did not depend so much upon 
an increase in the size of the contractile fiber-cells as upon an 
increased amount of round and oval globules, with amorphous 
tissue in the uterine walls. . . . The essential condition 
of the organ consisted in the elements of the different tissues 

* "Uterine Disorders," p. 221. t "Dis. of Women," 3d Eng. ed., p. 89. 

t" London Obstetrical Trans.," Vol. XIII, p. 239. 

7 



98 EATON ON DISEASES OF WOMEN. 

retaining a portion of the natural enlargement consequent 
upon impregnation. But this enlargement was more due to 
the increased size and amount of the soft tissue present in 
the walls of the uterus, as well as at the internal surface, than 
to the increased size of the contractile fiber-cells.' Marked 
congestion existed, the blood-vessels being large and forming 
a complete and continuous system with the capillary network 
on the inner surface of the uterus. No allusion to prepon- 
derance of muscular fibers is anywhere made, and no mention 
of fatty degeneration occurs. 

"The condition of the uterine cavity is important. It is 
always enlarged, the glands of the cervix are usually en- 
larged, and upon the lining membrane of the cavity fungoid 
growths are commonly developed. 

" This is all that can with positiveness be said of the 
pathology of the early periods of sub-involution in the pres- 
ent undeveloped state of the subject. 

" The uterus, the study of the tissues of which gave Dr. 
Beck's results, measured 3i inches in length, 21 inches across 
the fundus, the walls were II inches thick, and the uterine 
canal was 3 inches deep. 

"As time passes the uterine walls diminish in size, their 
tissue grows less vascular, the blood-vessels become smaller, 
and the uterine cavity assumes smaller dimensions. But the 
organ does not assume its original size; it remains large, 
dense, firm, and sensitive, for years presenting the character- 
istic appearances of the so-called chronic parenchymatous 
metritis. Although taking an entirely different view of the 
pathology of chronic metritis, Dr. West* signalizes almost 
the same fact in the following words : ' It must, however, be 
at once apparent that after inflammation has passed away, its 
effects may remain in the larger size and altered structure of 
the womb, and that the very nature of these changes will be 
such as to render the repair of the damaged organ both un- 

*"Op. cit.," p. 89. 



AREOLAR HYPERPLASIA OF THE UTERUS. 99 

likely to occur and slow to be accomplished, and must leave 
it in a condition peculiarly liable to be aggravated during the 
fluctuation of circulation and alternations of activity and re- 
pose to which the female sexual system is liable.' This is 
just the state to which I allude at the commencement of this 
chapter, as one existing years after labor, and which, attended 
by congestion, displacement, catarrh, and granular degenera- 
tion, is styled chronic metritis. It is, I think, this state which 
most frequently furnishes instances of areolar hyperplasia to 
the microscope. 

"Let any one patiently and faithfully watch a case of sub- 
involution for a year or two with reference to this point, as I 
have repeatedly done, and I can not doubt that he will have 
the same evidence which makes me so strong in my present 
belief. Lastly, let it be remembered that, by the French 
school, no condition of arrest of development is recognized as 
accounting for it ; these are cases of : post-puerperal metritis,' 
metritis, according to M. Gallard,* without symptoms, 'chron- 
ique d'emblee.' 

"Does any one claim that between this condition and 
chronic metritis a difference should be made ? Let him tell 
me by what means he can at the bedside distinguish one from 
the other, and I may agree with him. There are no means 
for such differentiation. If the uterus be very large and the 
patient recently delivered, the case is termed sub-involution 
by English writers ; if its dimensions have diminished, years 
have elapsed since parturition, and the almost universal ac- 
companiments of the condition, leucorrhoea, granular degen- 
eration, and displacement be present, it is styled chronic 
metritis. 

"Arrest of involution of the puerperal uterus is an occur- 
rence of very great frequency. It constitutes the chief cause 
of all chronic uterine disorders, and for this reason its impor- 
tance can not be overestimated. Until this subject receives 

*"Op. cit.,"p. 372. 



100 eaton on Diseases of women. 

the attention which it deserves, the present confusion as to 
the causes, pathology, and general features of chronic metritis, 
which helps to weaken uterine pathology, must continue. 

"In the first stage of the disease the hypertrophied 
areolar tissue is congested, containing absolutely more blood 
than normal, and the whole of the affected part, neck, body, 
or entire uterus, is greatly increased in size and weight. As 
time passes, the second stage of the disorder supervenes, and 
an opposite state of things is set up. Klob describes it in 
these words : ' The parenchyma on section appears white or 
of a whitish-red color, deficient in blood-vessels, from com- 
pression of the capillaries by the contraction of the newly 
formed connective tissue, or from partial destruction or oblit- 
eration of vessels during the growth of tissue ; the firmness 
of the uterine substance is also increased, simulating the 
hardness of cartilage, and creaking under the knife.' This 
constitutes a true sclerosis * of the uterus. 

"Every practitioner must have met with cases in which 
a large, red, engorged, and soft uterus, examined after an 
interval of several years, has been found, to his surprise, to 
have become small, densely hard, white, and anaemic, and its 
cavity diminished in size. Such an organ removed from the 
body cuts like fibrous tissue, and appears when cut almost as 
dense and bloodless. 

"Course and Termination. — The length of time which 
this condition may last is very uncertain. After the con- 
nective tissue once becomes thoroughly affected by the dis- 
ease, it rarely returns to its original condition; but so complete 
is the relief which may be afforded the patient by removal 
of those concomitant conditions that attend upon it and in- 
crease the discomforts which are due to it, that she will often, 
for years, imagine herself well. Very suddenly, however, 
imprudence during menstruation, the act of parturition, over- 

* The term sclerosis was, I believe, first applied to this condition by Skene, 
of Brooklyn. Subsequently Gallard likewise employed it. 



AREOLAR HYPERPLASIA OF THE UTERUS. 101 

exertion, or some other influence creating congestion, will 
produce a relapse which will convince her of her error. It 
is astonishing to what an extent enlargement of the cervix 
as a result of areolar hyperplasia will go. Sometimes this 
part will equal in size a very small orange, and, filling the 
vagina, will compress the rectum to such an extent as to 
interfere with its functions. Uninterfered with by art, the 
disease has no fixed limits. The increase of uterine weight 
which it induces usually results in displacement. This 
increases already existing congestion, and the patient suffers, 
until the menopause at least, from endo-metritis, granular 
cervix, and the ordinary symptoms of displacement. 

" In some cases contraction of the exuberant tissue oc- 
curs, and uterine atrophy, with its accompanying symptoms, 
takes place. 

"Frequency. — This affection is one of great frequency, 
and as it was formerly universally regarded as chronic paren- 
chymatous metritis, this is one great reason why inflamma- 
tion of the structure of the uterus was thought to be so 
common. This fact makes its careful study a matter of great 
moment to the gynaecologist. I do not hesitate to declare 
that he who fully masters it, and thoroughly appreciates its 
frequency and influence, will possess a key to the manage- 
ment of numerous cases which would in vain be sought for 
elsewhere. 

"Predisposing Causes. — These may be enumerated as — 

"A depreciation of the vital forces from any cause; 

"Constitutional tendency to tubercle, scrofula, or spa- 
nsemia ; 

"Parturition, especially when repeated often and with 
short intervals ; 

" Prolonged nervous depression ; 

"A torpid condition of the intestines and liver. 

" The Exciting Causes are the following : 
"Overexertion after delivery; 



102 EATON ON DISEASES OF WOMEN. 

" Puerperal pelvic inflammation ; 

" Laceration of the cervix uteri ; 

" Displacements ; 

" Endo-metritis ; 

" Neoplasms ; 

"Cardiac disease; 

"Abdominal tumors pressing on the vena cava; 

" Excessive sexual intercourse. 
"After delivery many of both these sets of causes are 
developed by the pernicious system of management which 
nurses frequently adopt. The nerve and blood states of the 
woman are depreciated by starvation, impure air, and disturb- 
ance of sleep by attention to the wants of the child, while 
the enlarged uterus is forced into retroversion, and the con- 
gestion which it induces, by a very tight bandage, rendered 
still more hurtful by a thick compress over the uterus. The 
practitioner who regards delivery of the placenta as the end 
of the third stage of labor furnishes a marked predisposing 
cause. The third stage of labor consists in complete and per- 
manent contraction of the uterus, and may not be accomplished 
for hours after the expulsion of the placenta. No obstetrician 
has done his duty who leaves his patient before its accom- 
plishment. 

" Symptoms. 

" It is impossible to present the symptoms of this condi- 
tion entirely separated from those of complications which 
very commonly attend it ; such, for example, as displacement, 
laceration of the cervix, ovarian congestion, granular cervix, 
etc. These states, of course, produce symptoms of their 
own, which mimxle with those of the main disorder. The 
symptoms, then, which are due to areolar hyperplasia, and its 
almost inevitable complications, are the following. If the 
cervix alone be affected, there are : 

" Pain in back and loins ; 

" Pressure on bladder or rectum ; 



AREOLAR HYPERPLASIA OF THE UTERUS. 103 

" Disordered menstruation ; 
" Difficulty of locomotion ; 
" Nervous disorder ; 
"Pain on sexual intercourse; 
" Dyspepsia, headache, and languor ; 
" Leucorrhoea. 
" If the affection be general or corporeal, graver symptoms 
manifest themselves/ 1 ' Chief among these are : 

" A dull, heavy, dragging pain through the pelvis, much 

increased by locomotion; 
" Pain on defecation and coition ; 
"Dull pain beginning several days before menstruation, 

and lasting during that process ; 
" Pain in the mammae, before and during menstruation ; 
" Darkening of the areolae of the breasts ; 
" Nausea and vomiting ; 
" Great nervous disturbance ; 

"Pressure on the rectum, with tenesmus and hemorrhoids; 
" Pressure on the bladder, with vesical tenesmus ; 
" Sterility. 

" Physical Signs of Cervical Hyperplasia. — Vaginal touch 
will generally discover that, the uterus has descended in the 
pelvis so that the cervix will rest upon its floor. The cervix 
will be found to be large, swollen, and painful, and the os may 
admit the tip of the finger. If the finger be placed under 
the cervix, and it be lifted up, pain will be usually complained 
of, and if it be introduced into the rectum so as to press upon 
the cervix as high as the os internum, it will often reveal a 
great degree of sensitiveness. Under these circumstances, 
the direction of the uterine axis will generally be found to be 
abnormal. The cervix will, in some cases, have moved for- 

* It must not be supposed that all these symptoms occur in all or even in 
the majority of cases. In many cases few, and in some almost none of them, 
will be recognized. 



104 EATON ON DISEASES OF WOMEN. 

wards and the body backwards, or the opposite change of 
place may have occurred. 

" Physical Signs of Corporeal Hyperplasia. — If. two 
fingers be carried into the vagina, and placed in front of the 
cervix so as to lift the bladder and press against the uterus, 
while the tips of the fingers of the other hand be made to 
depress the abdominal Avails, the body of the uterus will, 
unless the woman be very fat, be distinctly felt, should the 
organ be ante-flexed. Should it not be detected, let the two 
fingers in the vagina be now carried behind the cervix into 
the fornix vaginae, and the effort be repeated ; if the uterus be 
retro-flexed or retro-verted, or even in its normal place, it will 
be detected at once. By these means we may not only learn 
the size and shape of the organ, but its degree of sensitive- 
ness. This may likewise be accomplished, to a certain extent, 
by rectal touch. The uterine probe may then be introduced, 
the cavity measured, and the sensitiveness of the walls care- 
fully ascertained. 

"A point which should be settled before the diagnosis 
can be considered complete will be whether the cervix alone 
is affected, or whether its enlargement is only a N part of a 
general uterine development. To determine this question, 
two means are at command : First, the examiner, introducing 
one or two fingers under the body of the uterus, and depress- 
ing the abdominal walls by the other hand, so as to clasp 
the fundus, ascertains whether it is larger than it should be, 
or of normal size, and free from sensitiveness. He then 
passes the uterine probe into the cavity of the body, and 
measures it. If the uterine cavity be increased in size, the 
evidence is in favor of the disease having extended to the 
tissue of the body. Should its size be normal, this is prob- 
ably not the case. This sign is not, however, to be entirely 
relied upon. 

" Sometimes, suspicion of scirrhous cancer in an early 
period being entertained, it becomes necessary to decide 



AREOLAR HYPERPLASIA OF THE UTERUS. 105 

between its existence and that of the second stage of areolar 
hyperplasia, or sclerosis. Scanzoni doubts the possibility of 
deciding, but it appears to me that the investigator will 
usually succeed in doing so by the following comparison of 
signs and symptoms : 

In Cervical Sclerosis. In Scirrhous Cancer. 

"The patient shows no cachexia. She often does. 

"There is tendency to amenorrhea:!. There is tendency to hemorrhage. 

"The history usually points to parturition. It does not. 

"It has been preceded by symptoms of It has not- 
uterine enlargement. 

"The cervix feels like dense fibrous tissue. It feels almost like cartilage. 

"The body is, perhaps, implicated. It is very rarely so. 

"A sponge-tent softens the tissue.* It leaves it hard and dense. 

" Prognosis. 

" The prognosis in hyperplasia of the entire uterus, or of 
the body alone, is unfavorable with regard to complete cure, 
though highly favorable with reference to great relief of 
symptoms and to danger to life. Should the patient be 
approaching the menopause, it is possible that, after the 
functions of the uterus cease, atrophy may occur, and relief 
be obtained. But one can not be sure even of this, for the 
monthly discharge may give place to metrorrhagia, or all the 
symptoms may continue, in spite of the menstrual cessation. 
Under a course of local treatment, combined with one con- 
ducted with special reference to the general system, hope may 
always be held out that, although restoration of the uterus 
to its normal condition may not be effected, the evils result- 
ing from the complications of this disease can be so fully 
controlled that comfort will be obtained. When the neck of 
the uterus alone is affected, a favorable prognosis may always 
be made, for here there are fewer grave complications to be 
encountered; such, for example, as corporeal endo-metritis, 
menorrhagia, etc. The diseased part is likewise more access- 
ible to local treatment, and is also a much less sensitive and 

* This test originated with Spiegelberg. 



106 EATON ON DISEASES OF WOMEN. 

important part of the organism; I might, indeed, almost say 
a less important organ, so distinct are the uterine body and 
neck, physiologically and pathologically. As I have else- 
where stated, the prognosis will depend, in a great degree, 
upon the patient. If she be unwilling to sacrifice her incli- 
nations and pleasures, but half fulfill the directions of the 
attending physician, and clandestinely expose herself to 
prejudicial influences, the treatment will accomplish nothing. 
In the case of a reasonable patient, who appreciates what 
is at stake, and is anxious to regain her health, it may be 
regarded as favorable. 

" Treatment. 

"Rest. — The patient should be instructed to take much 
less exercise than usual, to lie upon her bed or lounge for 
an hour every day, about midday, and to be especially quiet 
during menstrual periods. It is highly improper to confine 
her to bed, for many women become restive under the con- 
finement, and suffer both in mind and body, the sanguineous 
and nervous systems being impaired by want of fresh air. 
If the connective tissue be so much affected that the cervix 
is very painful upon pressure, absolute rest upon the back 
may become necessary, but my impression is that deprivation 
of fresh air and exercise ordinarily does more harm than is 
compensated for by the advantages arising from quietude. 
Every day she should go, unless deterred by some special 
cause, into the open air; and a limited amount of exercise 
should be inculcated, as a means of keeping up the general 
health. 

"The uterus should be placed at rest as much as possible. 
Its natural tendency, under these circumstances, is to fall 
from its position; consequently, all pressure should be re- 
moved from its fundus by the use of a skirt-supporter and 
a well-fitting abdominal bandage." 

The use of the abdominal supporter I have found of the 



AREOLAR HYPERPLASIA OF THE UTERUS. 107 

utmost benefit; in fact, Ave doubt if these chronic cases 
can be successfully treated without its use. We would not 
dispense with them on any account. They need to be used 
with care and judgment, however. They must be made to 
fit so as to be really supporters of the abdominal viscera, and 
not compressors of the abdomen. (See improved London 
Supporter, Plate XII.) 

Sexual Intercourse. — Sexual intercourse is harmful in 
these cases as a rule, and should be prohibited in most cases. 

Diet. — The diet should be nourishing, but not stimulat- 
ing. It should be easily digested and taken in moderation, 
and at regular times only. 

Remedies. 

Ars. iod., Merc, iodide Phytolac. dec, Ferrum, Merc, cor., 
Kali idro., Nux, Ars. alb., Secale, Ignatia, Iris vers., 
Hyosc, Verat. vir., etc., are indicated remedies in this dis- 
ease, and the sympathetic affections dependent upon it. 
Special indications for these remedies may be studied best 
in works on Materia Medica. 

Remedies in Homoeopathic practice are not given according 
to the name of any disease, and must always be selected ac- 
cording to the pathogenesis of the drug, and we simply men- 
tion here the remedies most likely to be indicated to facili- 
tate the selection of the appropriate one, by the study of 
each individual case. I have named the remedies in the 
order in which they are prominent in regard to the fre- 
quency of their being indicated. 

Local Treatment. 

Some gentle local treatment we have found useful. The 
warm vaginal injection of water, using a large quantity, 
with a Davidsons syringe once a day, is of service. We 
think when there is a displacement of the uterus its reten- 
tion in situ is usually the thing to attend to at first. The 



108 EATON ON DISEASES OF WOMEN. 

displacement, though it may have been in a measure caused 
from this disease, may be a cause of its continuance. The 
malposition of the uterus tends to keep up an irritation of 
the nerves, and to cause an increase of the circulation in 
the parts. 

Displacements can not always be relieved at once, on ac- 
count of the tenderness of the parts. In such cases, we 
must direct the patient to take rest in the recumbent posi- 
tion, use warm vaginal injections of water, and take reme- 
dies for the relief of the tenderness. These remedies indi- 
cated by the tenderness are, Bell., Arnica, Aeon., Gelsem., or 
Verat. viride. We may also apply a wad of cotton saturated 
with glycerine to the cervix uteri. As soon as the uterus is 
sufficiently free from tenderness to allow of it, we should 
proceed to rectify the displacement. (See Displacements.) 

Now, in addition to the use of the homoeopathically indi- 
cated remedies given internally, we may use some local treat- 
ment. The object to be obtained is, absorption and con- 
traction. 

The local application to the cervix uteri, externally and 
internally, of a solution of Iodine, is the most efficient rem- 
edy we have found, using the solution of the strength of 
about ten grs. of Iod. res., and Potass, iodid., 3ss. to Aqua 
3i; applying this to the cervix with a soft brush, and to 
the cervical canal with a small uterine sound wrapped with 
cotton. These applications we would not make oftener than 
once in three clays. During treatment the daily use of the 
warm water vaginal injection is advisable. 

Scarifications of the cervix, blisters, and caustics we do 
not use, and can now say (after ten years of experience with- 
out them, and having had more than that number of years 
of experience in their use in hospital and private practice 
while in the old school), that we feel sure their use is 
harmful. Our experience is decidedly in favor of leaving 
them entirely alone. 



AREOLAR HYPERPLASIA OF THE UTERUS. 109 

Sponge Tents. — A sponge tent covered with glycerine, 
and placed for about six hours in the cervical canal, is often 
very useful. First, it dilates the canal so as to make it 
easier to apply the Iodine. It compresses the tissues so as 
to temporarily impede the capillary circulation, and the local 
application of the glycerine is also of service. In using the 
sponge tent caution must be exercised that the patient does 
not take cold. It better always be done at the patient's 
home, and the sponge should not be allowed to remain more 
than six or eight hours in this class of cases. 



110 EATON ON DISEASES OF WOMEN. 



CHAPTER X. 

PERI-METRITIS— PELVIC CELLULITIS— PELVIC ABSCESS. 

Peri-metritis indicates, strictly, an inflammation of that 
portion of the peritonaeum attached to and covering the 
uterus ; but, by common consent, it is applied to the inflam- 
mation of the peritonaeum situated within the pelvis. It is a 
frequent complication of cellulitis, and, when existing inde- 
pendently of cellulitis, has many symptoms in common with 
it. In a case of pure and primary peri-metritis we have not 
the effusion which takes place in cellulitis, and the tender- 
ness in the vagina is confined to the upper portion entirely. 
After the lapse of several weeks, we may have effusion of 
serum into that portion of the peritonaeum lining Douglas's 
cul-de-sac, and the case then may resemble recto-vaginal haema- 
tocelej though it is much smaller in size and is not so diffuse. 

Symptoms. 

The symptoms of peri-metritis are much like cellulitis. 
There is the stage of congestion, followed by fever and reac- 
tion, with the wiry, rapid pulse ; acute pain in the pelvis just 
posterior to the pubis. Vaginal examination does not reveal 
any evidence of inflammation in the cellular tissue. Slight 
pressure upon the uterus upwards produces no pain, but hard 
pressure causes much suffering ; the pain and tenderness 
being referred to the lower portion of the abdomen, just 
above or posterior to the pubis, about the fundus of the 
womb, and in the region of the bladder. There is not, how- 
ever, the frequent desire to pass water which we have in 
cystitis, as the lining membrane of the bladder is not affected. 



PERI-METRITIS. Ill 

There is some little pain from distension of the bladder, but 
the sensation is more often described as an uneasy feeling. 
Slight pressure in the lower portion of the hypogastric region 
produces pain, while in metritis, endo-metritis, etc., slight 
pressure causes no pain, but hard pressure can not be en- 
dured. Generally, in a few days, and sometimes in twenty- 
four hours, the inflammation extends over the peritonaeum, 
and we. have a case of general peritonitis. In some cases, 
however, the disease is arrested at once, and no extension of 
inflammation occurs. The disease may exist as a primary 
difficulty, or may exist as a complication of, or in connection 
with, the inflammation of some of the pelvic organs or vis- 
cera. The disease may be acute, chronic, or sub-acute. 
The acute form, though more dangerous, is not so likely to 
produce effusion as the chronic. 

' Etiology. 

It is probable that most primary cases of peri-metritis 
are the result of cold, generally taken at the menstrual 
period, or following surgical operations. But peri-metritis 
very frequently results from extension of inflammation in 
the uterus, ovaries, or cellular tissue, and occasionally the 
bladder. 

Treatment. 

The treatment must be in accordance with the stage of 
the disease and the special indications in each particular case. 
In the early part of the disease Ars. alb.. Aeon.. Br?/., or 
Arnica are indicated, while later in the disease Merc, cor., 
Merc, iod., Kali iod., China, Cimicif., Colocynth., or Nux are 
the remedies. Rest is necessary. The recumbent posture 
should be maintained, and warm applications be made to 
the feet and limbs. Cool, acidulated drinks are often grateful 
to the patient. The diet should be mild and non-stimulating. 
Fomentations of hops, or the hop or warm water compress, 



112 EATON ON DISEASES OE WOMEN. 

may be applied to the hypogastrium, and the warmth main- 
tained by coverings of dry flannel. 

Great industry should be exercised to arrest the inflam- 
matory action, by promoting the action of the skin and secre- 
tions generally, in this way establishing an equilibrium in 
the circulation, relieving the congestion and inflammation. 
Cathartics, anodynes, or the hypodermic syringe, are to be 
strictly prohibited. Meddling friends Avill often be suggesting 
these things, as well as turpentine externally ; but there is 
no way that proves satisfactory but a firm though kind re- 
fusal to allow of their use. Teach the people that benumbing 
the system is not curing the disease ; show them the bene- 
ficial effects of homoeopathic treatment by giving a single 
dose of Colocynthis (which is very often indicated in this dis- 
ease), and let them observe its effect, and then notice the 
freedom from nausea, constipation, and loss of appetite, pro- 
duced by opiates, to say nothing of the terrible effects of the 
opium habit, so often resulting from the administration of the 
drug, allopathically, for the relief of pain. 

Sequelae. 

The result most to be feared after peri-metritis is effusion 
of serum into the peritonseal cavity. If it does occur, Apis 
met, Ars. alb., China, Dig., Can. hid., Merc, iod., etc., are 
usually indicated. Sterility may be looked for as another 
sequel of peri-metritis, though it is not a certain result. This 
is owing to the thickening of the peritoneal covering of the 
ovaries from inflammatory action, and the consequent preven- 
tion of the escape of the ovum from the ovisac ; hence, it 
becomes impossible for the ovum to enter the fallopian tube 
or the uterus, and become impregnated. The retention of the 
ovum may cause the development of ovarian cystoma or 
fibroma; hence, we see that peri-metritis may be a cause of 
ovarian tumors. 



pelvic cellulitis. 113 

Pelvic Cellulitis. 

Cellulitis, Para-metritis, Pelvic Abscess, etc. — These terms 
indicate inflammation of the cellular tissue surrounding the 
uterus, vagina., fallopian tubes, ovaries, etc. The cellular tis- 
sue serves to fill up the interspace between the rectum and 
vagina; and, in fact, is a connective tissue which connects, 
and still separates, all the pelvic organs, and serves as a bed, 
in which are located the blood-vessels and nerves as well. 
This tissue is more liable to inflammatory action than is 
generally supposed, and many cases of cellulitis are over- 
looked and misdiagnosed, being denominated inflammation of 
the womb, neuralgia of the womb, irritable uterus, etc. 

Too much stress can hardly be put upon the necessity of 
more care in the diagnosis of female complaints, and espe- 
cially cellulitis. Many a patient suffers greatly and loses her 
life from a want of proper attention to the diagnosis and 
proper treatment of the diseases of her generative organs ; 
and perhaps no disease is more frequently unrecognized than 
cellulitis. The cellular tissue, being sponge like or honey- 
combed in structure, is adapted to the uses for which it was 
intended, allowing of the elevation of the uterus in gestation 
and its depression in prolapse. 

Cellulitis may affect the entire cellular tissue of the pel- 
vis, or it may be circumscribed and confined to a small space. 
In making a vaginal examination of a patient for the first 
time, we should always be careful to note any evidence of 
cellulitis, for otherwise we might use treatment which would 
be injurious. For instance, if we found a displaced uterus, 
and at once proceeded to replace it without any reference to 
the cellulitis already present, we would probably find great 
increase of pain, and the development of inflammatory symp- 
toms which might be severe and alarming. Cellulitis may 
develop as a, primary affection, or it may result from the 



114 EATON ON DISEASES OF WOMEN. 

extension of inflammation from some of the pelvic organs or 
from the peritonaeum. It was formerly claimed by authors 
that cellulitis only occurred as a result of displacement of 
some of the pelvic organs, or the extension of inflammation 
from some of them ; but it is now admitted to exist as a, pri- 
mary affection, although the pathology of the disease is not 
as well understood as could be wished, and it is hoped that 
more light will be found ere many years have passed, and 
we shall soon come to understand more thoroughly the pa- 
thology of this important disease. 

Prof. Emmet* claims that "cellulitis mod frequently exists 
as a primary affection, and that affections of the ovary, uterus, 
etc., are due, very often, to some previous lesion in the cell- 
ular tissue. He holds that the uterus is entirely dependent 
upon the blood which is distributed through the cellular 
tissue, and that, as the nerve filaments reach the uterus by 
the same route, the connective or cellular tissue is the first 
and most exposed to the influences exerted through the blood- 
vessels, and, consequently, is more liable to become inflamed, 
as he who transports nitro-glycerine is more exposed to dan- 
ger than he who is to receive it." 

Women are most liable to this disease during their period 
of menstrual activity, though it occurs occasionally after the 
cessation of the catamenia (probably about five per cent). 
Quite young girls are stated by Prof. Emmet to be liable to 
the disease. How he goes to work to make up a diagnosis in 
their cases he does not tell us, and I can not imagine. True, 
we might diagnose general pelvic inflammation in case of 
young girls; but I judge it is impossible for any one to very 
satisfactorily differentiate, in their cases, as to the particular 
part affected, and I do not think it important, as treatment 
should be very similar in their cases, whichever organ or part 
in the pelvis is affected. 

* Emmet, "Prin. and Prac. of Gynaecology," p. 260. 



PELVIC CELLCLITIS. 115 

Etiology. 

The causes which produce cellulitis in the female are, cold 
taken at or about the menstrual period, produced or acci- 
dental abortion, constipation, displacements of the uterus, cold 
taken after severe physical labor while in a perspiration, 
means used to prevent conception, severe and protracted 
labor, lacerations of the cervix uteri, the use of pessaries too 
Ions; continued, strong vaginal injections, excessive coitus 
(especially soon after marriage), allowing of the too great 
and protracted distension of the bladder; pelvic, ovarian, or 
uterine tumors, etc. The tubercular diathesis, conjoined with 
some local irritation, the climacteric period, gonorrhoeal infec- 
tion, local phlebitis, etc., may produce this disease. Unsat- 
isfied sexual passion in widows of full blood may also cause 
this disease ; as it may also, in the case of the married, where 
the passion is excited but not satisfied, owing to incapacity 
on the part of the husband. Fruitful married women are less 
liable to cellulitis than the sterile or unmarried. 

During the last quarter of a century the almost indiscrim- 
inate use of caustics to the os and internal surface of the uterus, 
by the allopathic medical profession, has been a fruitful source 
of cellulitis, which even their own authors are now willing to 
concede. How any body of intelligent, scientific, professional 
gentlemen could have adopted such a routine practice as this, 
causing such sad results in some cases (as they now freely 
acknowledge), and being of so little benefit in most cases, is 
truly astonishing. Too great faith in their leaders, and a blind 
following of their example, produced this unfortunate result, 
just as it did in the use of venesection and antiphlogistic 
treatment, so-called, almost universally used for many years 
by them, and now entirely, or almost entirely, abandoned for 
the tonic or the expectant treatment, which means stimula- 
tion, or the use of placeboes — or, as we say, blanks — and wait- 
ing for nature to accomplish a cure; the latter of which is cer- 



116 EA TON ON DISEASES OF WOMEN. 

tainly commendable, in that it shows either a great respect 
for nature and nature's God; or a distrust of the efficacy of 
their established routine, double-distilled, scientific treatment. 

Symptoms of I»elvic Cellulitis. 

The acute attack of cellulitis is usually ushered in with 
a chill, or at least chilly sensations, for a period varying from 
a few moments to several hours, when reaction sets in, and 
fever rises, with considerable pain in the pelvis. Sometimes 
the pain is sharp and piercing, at other times sore and aching — 
the sore, aching pain being most prominent in cases arising 
from excessive coitus or severe labor, while the darting, lan- 
cinating pain accompanies an attack caused from cold, either 
general or local. 

The general symptoms of an acute attack of cellulitis are 
similar to those in acute attacks of vaginitis, ovaritis, metritis, 
cystitis, or peritonitis. In cellulitis a vaginal examination 
will generally reveal tenderness on all sides of the vagina, 
although the vagina itself is but slightly increased in tem- 
perature or color. There is an absence of the intense redness 
and spasmodic tenesmus, usually present in vaginitis ; pres- 
sure upon the uterus produces little increase of pain, while 
in metritis this pressure could not be endured. The func- 
tions of the bladder are little disturbed, micturition being 
accomplished with tolerable ease, in great contrast to the 
extreme pain in this act accompanying cystitis. It will be 
understood I am now speaking of the recent attack of cellu- 
litis, for, in some instances, when the disease is not arrested, 
the inflammation extends to all the pelvic viscera, and we 
have a case of general pelvic inflammation, as well as 
cellulitis. 

Cellulitis may also be circumscribed. In this case it is 
somewhat more difficult of diagnosis. We then have local 
tenderness at the inflamed point, in connection with the gen- 
eral symptoms enumerated. Defecation is usually painful, 



PELVIC CELLULITIS. 117 

and constipation a prominent symptom. In the early stages 
the blood vessels, being full in the cellular tissue, and the 
circulation obstructed, a condition of congestion is present, 
which not only gives rise to the pain, as well as the tender- 
ness on pressure, but soon causes effusion of serum into the 
cellular tissue, giving rise to a feeling like the vagina was sur- 
rounded with cotton batting, pressing it inwards and decreas- 
ing its size. We must be careful not to confound this 
narrowing of the vagina with recto-vaginal hematocele, as we 
may distinguish it by its presence in the posterior part of 
the pelvis entirely, and not affecting the anterior portion at 
all; besides, in recto-vaginal hematocele the size of the effu- 
sion (or the apparent tumor caused by the effusion) is much 
greater in the same length of time than is present in cellu- 
litis. After two or three weeks we may have an abscess 
form posterior to the vagina, and greatly resemble in its 
physical features a recent hematocele; so time must be an 
element in making up the diagnosis, as also must the history 
of the case. Nausea and vomiting are often symptoms in 
these cases, as well as severe headache. Perhaps headache 
is the most constant symptom with which we meet in chronic 
cellulitis, though backache and a. sense of weight in the pelvis 
are very common. Hysterical symptoms of almost any form 
are liable to be manifested in this disease. 

There also exists, in a great many patients, a chronic form 
of cellulitis, where the symptoms of the acute attack have never 
been experienced, cellulitis being, in these cases, the result of 
the extension of inflammation from some of the pelvic organs 
or viscera, the symptoms of tenderness and effusion having 
been so moderate as to have been overlooked or ascribed to 
some other ailment. The pain in these chronic cases is 
usually of a burning character. The patient is often tortured 
with hot flashes, becomes easily fatigued, is very nervous, 
and complains of all manner of absurd and conflicting symp- 
toms ; is usually peevish, fretful, notional, and whimsical. 



118 EATON ON DISEASES OF WOMEN. 

Sometimes she is emaciated, but is often of full habit, having 
a good appetite and digestion. In these cases a sense of 
weight in the pelvis and bearing-down pain is usually com- 
plained of, and pain in the back as well, especially after 
exercise. A physical examination, however, reveals no pro- 
lapse or version of the uterus, although there is a supersensi- 
tive condition of the entire pelvic contents, and often the 
tenderness is greatest in one or both iliac regions. 

In cellulitis the passing of the sound into the uterus, even 
to the fundus, would produce no special pain, while in endo- 
metritis the pain would be intense from its introduction. This 
is an important point in differential diagnosis between endo- 
metritis and cellulitis. In the introduction of the sound for the 
purpose of diagnosis great care should be exercised that no vio- 
lence is done the mucous membrane. In fact, this care is 
always necessary in making an explorative examination for 
the purpose of differentiating in a case where we find that 
pressure upon the os causes pain to be felt higher up, and 
pressure above the pubis causes some pain, and there is 
apparently some supersensitiveness on the sides and upper 
portion of the vagina, with only mild symptoms of inflam- 
matory action, without hemorrhage. 

The use of the speculum is hardly ever required in making 
the diagnosis of an acute attack of cellulitis. By separating 
the labia we may see enough of the vaginal mucous membrane 
to satisfy us, in connection with the digital examination, 
whether the case is one of vaginitis or cellulitis. In either 
vaginitis or cellulitis, the speculum causes too much pain in 
its use to cause it to be recommended, even in diagnosis of 
these cases ; for I take it for granted that a, digital exam- 
ination should always precede a specular examination in all 
cases, in making an examination for the purpose of diagnosis ; 
and we can learn enough by the introduction of the finger to 
assure us of heat and tenderness, the location of the tender- 
ness and its extent, the amount of effusion and congestion 



PELVIC CELLULITIS. 119 

of the tissues, the position of the pelvic organs in the main; 
and. in the few cases where we are not satisfied there is not 
a flexion of the uterus, with digital examination, we can 
gently introduce the sound, and clear up that much of the 
diagnosis. I lay it down as a general principle of gynaecolog- 
ical practice that we should never attempt to introduce the 
speculum when a digital examination gives any considerable 
pain. (The tenderness should be first removed by suitable 
treatment.) 

Prognosis. 

The prognosis of cellulitis will be favorable, in most cases, 
of acute attacks, if treated promptly and rationally, terminat- 
ing generally in resolution, leaving the uterus less movable 
than normal, however, oAving to adhesions which usually form 
at some part of the location of the inflammation. We may 
also detect the band-like or corded feel of the folds of 
some portion of the vagina, generally its upper part. These 
are also caused by adhesions, and may offer considerable 
resistance to the advancement of labor, should gestation 
occur. In some instances, however, suppuration develops, and 
a pelvic abscess is formed, and may point in the vagina or 
find exit through the rectum, the opening of the abscess 
into the rectum being the more common. Or the abscess 
may open into the bladder in rare instances (only one case 
of this kind has come under my personal observation); 
or we may have blood poisoning from the absorption of the 
pus, in which case we have rigors and fever, with great 
nervous prostration, and death may result. 

In occasional instances the pus has found exit through 
the small intestines, owing to adhesions between them and 
the sac of the abscess; and the pus may follow down the 
psoas muscle, and open in the groin; or it may pass through 
either sciatic foramen, and burrow under the glutei muscles, 
or it may become sacculated, and remain for years, 
causing a diagnosis of fibroid to be made; or it may be 



120 EATON ON DISEASES OF WOMEN. 

entirely overlooked until, for some reason, some inflammatory 
action is set up, and even then it may be mistaken for a 
recent attack of cellulitis. Generally the abscess discharges 
voluntarily, or is evacuated artificially, at its most depend- 
ent portion, and the pus is very thoroughly drained off, 
leaving the sides of the sac of the abscess in contact, causing 
adhesions and a cure of the whole trouble with little treat- 
ment except of a general character. In chronic cellulitis we 
may look forward to a protracted, if not an incurable, case; 
for generally the ovaries and uterus are more or less involved, 
and the nervous irritability is such that the patient suffers 
much from prostration. The symptoms being someAvhat 
obscure, the patients are said to go into a decline, which 
simply means they run down, and no one knows what is the 
matter with them. 

Sterility is a common result of pelvic cellulitis, which 
is caused from the organization of the plastic material 
thrown out around the ovaries, making it impossible for the 
ovum to escape from the ovary; or sterility may, in these 
cases, be caused from the adhesion of the fallopian tube in 
such a way as to prevent its receiving the egg" at all. 
Hence, we see that cellulitis may be a prime cause of ovarian 
inflammation and tumors, in that it may prevent the escape 
of the ovum, and it may prove the nucleus of a cystic or 
fibro-cystic growth. Cases which early come under homoeop- 
athic treatment are usually relieved without the formation of 
pus, and chronic cases are relieved with homoeopathic reme- 
dies which have bidden defiance to old-school treatment. 
Occasionally, however, chronic pelvic cellulitis may take on 
active inflammatory action, and pus may form as in acute 
attacks, which go on rapidly to suppuration. One attack of 
cellulitis offers no immunity from subsequent attacks, but 
rather predisposes to them. 

Complications in Pelvic Cellulitis. — The extension of 
inflammation from the cellular tissue to the peritonaeum is 



PELVIC CELLULITIS. 121 

the most common complication in this disease, although me- 
tritis, cystitis, and rectitis are not of infrequent occurrence. 
If we do not see the case till several days after the attack, 
and fully developed peritonitis has resulted, we will have 
only the history of the case to aid us in diagnosing it from 
ordinary attacks of peritonitis. We have the tenderness on 
slight pressure over the abdomen, the tympanitic condition, 
wiry pulse, great prostration, constipation, loss of appetite, 
fever, frequently accompanied with profuse perspiration, as in 
ordinary attacks of peritonitis; but the history of the case 
will show that the pain in the pelvis was manifested one or 
more days before it occurred in the abdomen. A vaginal ex- 
amination will show the tenderness of the connective tissue, and 
will probably indicate some effusion into this cellular tissue, 
showing that the origin of the disease was in the cellular 
tissue of the pelvis, and consequently the case is one of 
cellulitis complicated with peritonitis, and should be so desig- 
nated. The gravity of this case is much greater than ordi- 
nary peritonitis, which is always serious. 

The symptoms of rectitis, as a complication, are those 
present in dysentery in connection with those in pelvic cel- 
lulitis. There is diarrhoea, tenesmus, ineffectual urging to 
stool, with no operation, save a little mucus ; or blood; while 
in peritonitis, as a complication, there is no urging to stool, 
not even a desire for stool, although the pain in the abdo- 
men may be of great severity. When cystitis complicates a 
case of cellulitis, there is the frequent desire to pass water, 
accompanied with pain in the effort and a sensation as if 
there was more urine to pass, which can not be discharged. 
This is owing to the presence of mucus in the bladder, 
which is very tenacious, and difficult to dislodge, and its par- 
tial entrance into the urethra, as well as the inflammation in 
the bladder, causes the feeling of frequent desire to mic- 
turate. The presence of the urine in the bladder, even in 
small quantities, in its inflamed condition, tends to produce 



122 EATON ON DISEASES OF WOMEN. 

this feeling also. These symptoms, taken in connection with 
(hose of cellulitis, clearly show cystic complication. The 
pain is not so much in these cases at the time of the flow 
of the urine through the urethra, as in urethritis, but follows 
the flow, as a sort of straining, or tenesmus. Urethritis may, 
however, be present, due to extension of the inflammation 
from the cellular tissue or otherwise, and in that case we will 
have the scalding, burning pain in the urethra while the 
water is passing. 

Treatment. 

In the first stage, or that of chill, Arsenicum is most 
prominently indicated, with the warm foot bath, and warmth to 
the limbs. The full warm bath, succeeded by a warm pack 
in a warm wet sheet, with the administration of large 
draughts of moderately cool water, will frequently establish 
the equilibrium of the circulation. In this case the disease 
is aborted in its first stage, and we can only denominate it as 
congestion of the pelvic organs. 

It is not often, however, that we are called to a patient 
in this stage, and Ave usually find that reaction is fully es- 
tablished in the general system, and fever, with a rapid, wiry 
pulse, is present, although there is still evidence of conges- 
tion in the pelvic cellular tissue. The remedy indicated in 
this case is generally Aconite, although, if the cause is from 
excessive coitus or protracted and severe labor, Arnica should 
be alternated with the Aconite, and followed in a day or two 
with Bry. or Mercurius, if there is a tendency to suppuration. 
Bell., Hyos., Plat., Cimicif., etc., are sometimes indicated. 
(See their pathogenesis in works on Materia Medica.) 

The hygienic measures necessary are, first, perfect rest in 
the recumbent posture, with the thighs partially flexed upon 
the abdomen. The patient should be enveloped in flannels from 
neck to foot. Warm vaginal injections with an elastic syringe 
should be used freely, with the patient recumbent, a bed-pan 
being placed under her to receive the water as it passes out 



PELVIC CELLULITIS. 123 

of the vagina. Warm injections per rectum are also of great 
service. The food should be very light and non-stimulating. 
Cold water may be drank freely. The vaginal and rectal in- 
jections of warm water should be used every three or four 
hours for some time, till the evidences of active inflammation 
subside. Should pus form, I prefer to evacuate it artificially 
in the vagina, if possible, as its opening into the rectum, 
colon, small intestines, or bladder, or even into the groin, 
makes a more troublesome case, and there is very much more 
danger of fatal results. Some cases result favorably, how- 
ever, when the pus escapes through these outlets by ulcer- 
ative action. 

Some cases of chronic cellulitis, sub-acute in character, as 
all cases of chronic cellulitis are (unless, from some exciting 
cause, acute inflammation supervenes upon the chronic sub- 
acute inflammation), will nearly baffle all the remedial measures 
and remedies we can employ. Here it is necessary to look well 
over the general system, and ascertain the functional derange- 
ment or organic lesion, if any there be, which may so affect 
the system as to keep up the disease or prevent its cure. 
Sometimes it will be found to be a displacement of the uterus, 
sometimes disease in the rectum; at other times we find its 
explanation in the tubercular diathesis of the patient, impu- 
rity of the blood, or some disease or tumor of the uterus or 
ovaries. Sometimes these difficulties can be relieved and 
removed, and sometimes not. If possible, we must, of course, 
remove the cause of the irritation, which, if we can accom- 
plish, will enable us to get relief from the tenderness, back- 
ache, weight in the pelvis, etc., by the use of Nux, Rhus, Ars., 
China, Bryonia, or Pulsatilla. When the disease is depend- 
ent upon impoverished or impure blood, w T e find great benefit 
from Iod., Ars., Phytolac. dec, China, Merc, Thuja, etc., as 
indicated. The application of a Solution of Iodine, ten grs. to 
the ounce, to the vaginal mucous membrane, by means of a 
brush, used through the speculum once in three days, with the 



124 EATON ON DISEASES OE WOMEN. 

external application of Colorless or Tr. Iodine above the pubis, 
together with attention to the movement of the bowels resru- 
larly, will greatly aid in the cure of these cases. 

Supporting the abdominal viscera by an abdominal sup- 
porter is often a great relief to the patient, and a measure 
calculated to be of service in the cure, as it relieves the 
tender parts from being pressed upon by the weight of the 
abdominal organs when in the erect posture. In the chronic 
form of cellulitis attention must be paid to the promotion 
of healthy digestion and assimilation, as well as the general 
nervous recuperation. Generous, easily digested diet, with 
moderate exercise and pure air, as well as medicine, are 
necessary. The exercise must be moderate, however; hard 
labor, or riding in a hard vehicle, over a rough road, could 
not be tolerated. Even sweeping carpets and making beds 
must be prohibited. Sexual connection must be forbidden. 
The tepid sitz bath, daily, is of much service, as is also a 
general sponge bath, followed by active friction to the ex- 
tremities and back. Do not be inveigled into the use of 
anodynes, either by the stomach or by the use of that con- 
temptible little instrument, the hypodermic syringe, which 
has done more harm than decades can eradicate, in the 
establishment of the opium habit. We, however, withdraw 
objection in case of cancerous disease (which is hopeless), 
and, perhaps, some other hopeless cases, as mangling from 
external violence of such severity as to preclude the hope 
of recovery. Listen not to the importunities of patient 
or friends; do for the patient what your judgment dictates. 
Cheer the patient with all the hope you can honestly give 
her, and explain the injurious after-effects of anodynes, and 
help her to be brave by your own tranquillity, and have firm 
faith in the remedies and means used. 

The complications of cellulitis must be treated on the 
general plan laid down when they occur as separate diseases, 
using remedies singl}', however, and not making a mixture 



PELVIC ABSCESS. 125 

of remedies because you have a complication of diseases. 

If two or three remedies seem to be about equally indicated 

it is well to give one for a few days, then omit it, and use 

another for a time. We then get a better action of the 

remedy, and Ave also learn something for our own, or some 

one's, future use. 

Pelvic Abscess. 

Abscess in the pelvis, resulting from pelvic cellulitis, is 
not of very infrequent occurrence. We know of its forma- 
tion by the occurrence of rigors and the soft, fluctuating feel. 
When we are certain that an abscess has formed, it is best 
to evacuate it if possible through the vagina with the long 
curved trocar. 




Fig. No. 5.— Long Curved Trocar 



Allowing the pus to remain can do no good, and it may 
do much harm by its absorption into the circulation, or it 
may point and cause ulceration in very inconvenient locali- 
ties, as into the bladder, intestines, or peritonaeum. Usually 
draining the abscess with the trocar allows the sides of the 
walls of the sac to come together and adhere, and causes a 
cure of the abscess ; but if it does not, and more pus forms, 
we may evacuate it again in the same way, and folloAv the 
evacuation of the pus with injections into the interior of 
the sac of a Solution of Iodine, ten grs. to the ounce. Instead 
of the curved trocar, we may evacuate the pus with the Aspi- 
rator. (See chapter on Instruments, and Plates IX and X.) 



126 EATON ON DISEASES OF WOMEN. 



CHAPTER XL 

CHILD-BED FEVER. 

PUERPERAL PERITONITIS, PUERPERAL METRITIS, METRO-PHLEBITIS, AND 

PERITONITIS. 

This disease, occurring as it does after parturition, is 
treated of in some works on obstetrics, but not in all, and, as 
it is one of the diseases peculiar to women, I deem it properly 
considered in a treatise upon " Diseases of Women," although 
very generally omitted in these special works. Puerperal 
fever indicates something more than a fever occurring after 
delivery. It consists of an inflammation of the womb, gener- 
ally accompanied with peritonitis and following delivery but 
a few days. By some, the term has been restricted to the 
malignant, epidemic form of the disease. It is essentially an 
inflammation, accompanied with a severe fever, and it is 
more. It includes a blood poisoning, also. The inflamma- 
tion may be seated mostly in the muscular tissue of the 
uterus ; or it may be in the uterine veins, being then a uterine 
phlebitis ; or it may mainly affect the peritonaea! tissue ; or it 
may affect all the pelvic organs, and extend to the abdominal 
viscera as well. The nervous system does not escape in this 
disease, and we have extreme prostration of strength very 
much like that which we have in typhus fever. 

Unfortunately, the writings of authors of eminence upon 
this disease have been so conflicting, not only regarding its 
treatment, but also its symptoms and pathology, that the 
term "puerperal fever," unexplained and unqualified, conveys 
to the mind of the experienced, thorough physician no assur- 
ance of the real nature or severity of the complaint, unless 
he is aware of the ideas entertained by the speaker upon 



PUERPERAL PERITONITIS. 127 

this disease. During the last few years those of the profes- 
sion Avho exercise most care in nomenclature and diagnosis 
have discarded the use of the term puerperal or child-bed 
fever, and use the terms puerperal peritonitis, or puerperal 
metritis, instead. This is much the more satisfactory method 
of nomenclature. 

A few years since it seemed to me to be my duty to 
criticise the remarks of a prominent author, made to a large 
number of medical gentlemen of the North-west, in the par- 
lors of the Grand Pacific Hotel, Chicago, upon puerperal 
fever, he including phlebitis of the extremities, milk fever, 
pneumonia, and intermittent fever (occurring in the puerperal 
state), as well as abscess of the breast, septiccemia as well as 
pycemia, under the general head of puerperal fever. He 
had the perception and manliness to acknowledge the justice 
of the criticism I made, and expressed the hope that 
hereafter the profession would be more careful in medical 
nomenclature. 

On the one hand, it might be considered that partu- 
rition, being a physiological process, it should not very 
materially tend to disease. On the other hand, when we 
consider the large dimensions to which the uterus attains 
at full term of natural gestation ; the consequent displacement 
of the abdominal viscera ; the pressure to which the kidneys, 
liver, and stomach are subjected; the obstruction offered to 
the free action of the bowels ; and the consequent derange- 
ment of digestion and assimilation, we may wonder that 
disease is not a constant effect of this process. 

When we consider the violent straining and tension to 
which the muscles of the body are subjected in the process 
of the expulsion of the child, both in natural and abnormal 
deliveries; the depression and exhaustion to the nervous 
system, caused by this process, we Avonder more and more 
that the recoveries from confinement are as favorable as 
they are. 



128 EATON ON DISEASES OE WOMEN. 

Any student, by making a careful study of puerperal 
peritonitis or metritis, will, from the history and description 
of the disease given by different authors, become convinced 
that it sometimes occurs epidemically, sometimes sporadically, 
and sometimes as the result of contagion or infection; and 
that it sometimes follows the easiest as well as the most 
severe labors; that it occurs in the robust as well as the 
weak; that there is generally .evidence of blood poisoning; 
but whether it be from atmospheric conditions, or from the 
absorption into the system of poison from the person of 
the accoucheur, or the putrid matter within the uterus from 
decay of a portion of retained placenta, or from cold and the 
arrest of the natural secretions, he will not be prepared to 
say. He will feel sure, however, that either of these causes 
may develop the disease. He will be convinced that the 
accoucheur can not, with safety to the patient, attend cases 
of confinement while he has in charge a case of puerperal 
peritonitis, and that he can not safely dress suppurating 
wounds and then attend cases of confinement. He will also 
be convinced that a case of puerperal peritonitis may arise 
in the practice of any physician, in spite of the utmost care 
and caution on his part. 

The nervous system is claimed by some to be the seat of 
all the derangements of the system, and especially puerperal 
diseases. M. Flourens* says: " The form of the nervous 
system determines the form of the entire animal, and the 
reason why it is so is plain; it is because, in fact, the ner- 
vous system constitutes the entire animal, all the other sys- 
tems being added merely to serve and maintain it." Meigsf 
says : "That the nervous system is the only part or element 
upon which medicines, miasms, or contagions can act." (This 
theory should make a homoeopathist of him, as in it is found 
one explanation of the perceptible action upon the system 

* Analyse Raisonnee des Travaux de Georges Cnvier, page 88. 
t Meigs's "Obstetrics," page 642. 



PUERPERAL PERITONITIS. 129 

of the minute dose.) But, however we may theorize, we 
may as well, first as last, admit that all cases of puerperal 
peritonitis do not result from the same cause ; but to one 
thing we can adhere, that in every genuine case of puerperal 
peritonitis there is blood poisoning and nerve depression, and 
that a certain train of symptoms are necessary to indicate 
the disease. 

Symptoms. 

The first symptom which presents itself in an attack of 
puerperal peritonitis or metritis is a chill, either affecting the 
whole or a part of the body, and varying in severity from 
mild, chilly sensations to severe rigors, causing shivering and 
chattering of the teeth. This chill comes on generally with- 
out premonition, often occurring in those cases which have 
for two or three days, and sometimes a week after delivery, 
seemed to be doing well. In some cases, however, there is 
some premonition of the attack in an increase of the rapidity 
of the pulse previous to the chill, with a feeling of exhaus- 
tion or excitement. 

The occurrence of a chill does not, however, indicate 
with certainty the attack of peritonitis, as it may be due to 
the secretion of the milk or the commencement of an ordi- 
nary intermittent or bilious attack of fever. In the attack 
of puerperal peritonitis there is fever following the chill, so 
there is also in intermittent and bilious attacks ; but in the 
attack of peritonitis we have tenderness over a portion or a 
whole of the abdomen, generally commencing in its lower 
portion and extending upwards; we also have a wiry pulse, 
which Ave do not have in intermittent or bilious fever. 

Pain in the abdomen and pelvis is another symptom in- 
dicative of this disease. This pain is greatly increased 
by pressure, even very gentle pressure often producing 
acute pain — sometimes the weight of ordinary clothing 
can scarcely be endured. The patient draws up the limbs 



1 30 EA TON ON DISEASES OF WOMEN. 

and flexes the thighs upon the abdomen. Great thirst 
is complained of, and the swallowing of cold water often 
causes vomiting. In some cases the mind wanders, in others, 
the patient insists that she is getting along nicely, seems uncon- 
scious of her condition, and does not seem to suffer pain 
except when some pressure is marie over the abdomen, or 
she attempts to move in bed. Tympanites over the entire 
abdomen is soon manifested ; though percussion is very 
painful we may use it enough to satisfy ourselves of the 
actual condition present, though it would be very unwise to 
subject the patient to frequent examinations by percussion. 
The tongue, at first red or furred in the center, with red 
edges and tip, becomes dry and fissured. There is inability 
to obtain rest in sleep in most cases, though sometimes an 
almost constant drowsy, semi-comatose condition is present. 
Profuse perspiration is sometimes a constant symptom after 
the first few days of the disease, although the pulse remains 
frequently up to 130 or 140 beats per minute. It becomes 
softer in favorable cases, and gradually diminishes in frequency. 
Sometimes the skin remains dry and hot. The temperature 
of the body is high, ranging from 103° to 105°. As a gen- 
eral rule, the higher the temperature the more grave the case. 
Dr. Blundell * has given the term hidrosis, or hidrotid fever, 
to this disease, when characterized by very profuse perspira- 
tion. He divides these cases into seven varieties, " the ultra 
malignant, the malignant ', the acute, the lingering, the mutable, 
the fugacious, and the remittent" (which is splitting hairs when 
we have no use for the hair). It amounts to no practical ad- 
vantage, but would tend to make more intricate that which is 
poorly enough understood at best when made as plain as pos- 
sible. The secretion of milk is generally arrested, and the 
child has to be fed artificially. The bowels are usually con- 
stipated. This is a more favorable symptom than diarrhoea, 
as diarrhoea in this disease indicates that the peritonitis has 
* " Obstetricy," by Costle, p. 770; Ramsbotham, p. 545. 



PUERPERAL PERITONITIS. 131 

enteritis as a complication, greatly increasing the gravity of 
the case. There is great prostration of strength, with entire 
loss of appetite. The breath is offensive. The lochia is gen- 
erally arrested, and the odor of the vaginal discharge (if there 
is any) is very putrid and nauseating. The eye looks glassy 
and inexpressive. The countenance is sallow, dejected, and 
ghastly. Sometimes a metastasis of the inflammation takes 
place, and the disease suddenly seems to leave the perito- 
naeum and attack the pleura; but in these cases there are not 
all the symptoms of puerperal peritonitis fully developed, and 
the case is one which some authors, especially Professors 
Iiamsbotham and Keating, have denominated false peritonitis, 
which is more of a neuralgic than inflammatory condition, 
though it manifests many symptoms indicative of genuine 
puerperal peritonitis. Sometimes pain in the back is more 
complained of than any thing else. Frequently there is 
almost an entire arrest of the secretion of urine, and in these 
cases the pain in the back is doubtless due to congestion of 
the kidneys, causing the arrest of the natural secretion. Cold 
hands and feet I may also mention as generally present in 
this disease, although the body is unnaturally warm. Blue- 
ness of the skin, with obstructed respiration, may be some- 
times noted. 

Etiology. 

Upon the cause of puerperal peritonitis there is a great 
diversity of opinion. From my own experience, and all I 
can learn from authors and the experience of my brethren, I 
am of the opinion that the causes are various, but producing 
a uniform effect upon the nervous system through the agency 
of the blood, sometimes by inhalations of poisonous gases, 
sometimes by absorption of poisonous gases, or matter in the 
uterus, and sometimes from cold. The arrest of the process 
of involution of the womb after labor, on account of lacera- 
tions of the cervix, makes it requisite that there should be 



132 EA TON ON DISEASES OF WOMEN, 

considerable discharge per vagina m; An irregular contraction 
of the womb, so as to cause retention of this effete matter, 
may cause the generation of such poisonous gases as might 
develop the phenomena we witness in this disease. The re- 
tention and putrefaction of a bit of placenta may produce the 
same result. The removal of so much pressure as has been 
exerted upon the abdominal viscera by the gravid uterus 
tends to render the parts liable to congestion and subsequent 
inflammation. Doubtless epidemic influences are such, in 
some instances, as to merit the term contagion, though it is 
clear that contagion is not necessary to the development of 
the disease. The coincident occurrence of epidemics of ery- 
sipelas and puerperal fever have led some to suppose the dis- 
eases were interchangeable ; bat this manifestation is doubt- 
less simply the effect of the atmospheric conditions which 
have favored the development of these diseases, the nature 
of these conditions of the atmosphere being as yet unknown. 

Prognosis. 

Sporadic cases will usually terminate favorably under 
proper treatment; but in severe epidemics a considerable 
number will be lost under the best treatment. The disease, 
when terminating favorably, generally results in resolution, 
but sometimes leaves an effusion of serum in the peritonaeal 
cavity, called abdominal ascites. This may be absorbed by 
the powers of nature, assisted by remedies, or require artificial 
evacuation by tapping. 

Complications. 

The extension of the inflammation from the uterus and 
peritonaeum to the cellular tissue, ovaries, etc., is not infre- 
quent, and sometimes causes sterility, from the effusion of 
plastic lymph around the ovaries, as in pure cellulitis; or pus 
may form in the cellular tissue, or between the layers of mus- 
cular tissue, in the uterus, or in the peritonaea! cavity. In 



PUERPERAL PERITONITIS. 133 

the latter case it is rapidly fatal. Cystitis, pleuritis, puer- 
peral mania, or cerebral meningitis sometimes complicate 
the case. 

Post-mortem Appearances. — These are quite uniform. The 
abdomen is large and tense. On opening it, there is an 
escape of fetid, nauseous gas. The peritonaeum is found 
highly vascular, with discolored patches, and some evidence 
of pus at these points. The omentum is thickened, and a 
considerable quantity of turbid serum is found in the perito- 
neal cavity. The womb is sometimes found to be normal in 
appearance ; at others so soft as to allow of being easily torn 
to pieces with the fingers. 

Treatment. 

If we are so fortunate as to see the patient during the 
onset of an attack while there is coldness or rigors, Ars. alb. 
is indicated, administered in the 3 X trituration, in the dry 
state, upon the tongue, every quarter or half hour. Place 
the feet in a very warm foot bath. This is best done in 
this case by allowing the patient to lie upon her back in 
bed, with the limbs drawn up, and the feet placed in the 
small foot bath-tub, which can be slipped under the bed- 
clothins;. The tub should be well warmed before being 
used, so as not to chill the patient should she chance to nit 
her limbs against its edges. 

As soon as reaction is established, Aconite in low dilution, 
alternated with Sulph. is demanded, and should be continued 
until free diaphoresis is established. In place of Sutyh, Kali 
chlo., l x trituration, given every two hours, is of great serv- 
ice. After the perspiration has continued for several hours, 
blanks should be used for a time, to allow us to see the 
condition of the patient when -not taking medicine; if fever 
is found to be mostly gone for a few hours, and the case 
shows clearly that the attack was not due to the secretion 
of milk (it having been secreted before the chill or it is 



134 EATON ON DISEASES OF WOMEN. 

too early for the milk to come), we do well to give one gr. 
doses of Sulph. Quinia every two hours for a day or so, 
especially if we have a white coating upon the tongue, and 
aching of the limbs is complained of. If nausea is a promi- 
nent symptom, together with general aching, Ars. alb. should 
take the preference of the Sulph. of Quinia. In case fever 
returns, there is no further use for Quinia. We must use 
either Kali chlo., Sulph., Carbol. acid, Iodine, or Ars. iodid., 
with intercurrent remedies, as indicated. They will be 
found among the following: Bell., Aconite, Bry., Rhus 
tox., Apis mel., Verat. viride, Merc, etc. When convales- 
cence is established, China, Nux, Puis., etc., are useful 
according to their most prominent homoeopathic indications. 
During the greatest activity of the fever, Aconite low has 
served me well, generally in alternation with Iodine 6 X or 
Sulph. 30 x . Bell, takes preference of Aconite if the dullness 
of the sensibilities is the most prominent symptom. Verat. 
viride, so useful in pleuritis, I haA^e not found satisfactory 
in peritonitis, though some have claimed to obtain excellent 
results from its use in this disease. Beef tea is the most 
satisfactory diet; cool water may be given freely;' hot teas 
and stimulants are hurtful; warm compresses to the abdomen 
are used by many, but, on account of their dampness, are 
not very desirable. Where there is extreme tenderness the 
compress should be wet with warm hop water, and kept 
in situ with a flannel bandage. In most cases the dry flan- 
nel bandage, evenly applied, is all the local application nec- 
essary. Vaginal injections of tepid water and castile-soap, 
followed by an injection of Liq. Soda chlo., one part to six 
of water, are of service — using the injection of a tempera- 
ture high enough not to chill the patient. Intra-uterine 
injections of Solution of Iodine, two to five grs. to the ounce, 
are sometimes promptly beneficial in very bad cases, espe- 
cially when the evidence is clear of the suppurating condition 
in the interior of the womb. 



PUERPERAL PERITONITIS. 135 

Good air is another necessity in the successful treatment 
of puerperal peritonitis, or metritis. The old style of keep- 
ing the patient in a small room, with every crevice carefully 
closed to prevent the ingress or egress of a breath of air 
should never be followed; but, on the contrary, see to it 
that a free supply of fresh air is admitted to the sick-room, 
and abundant means are secured for the passing out of the 
impure, poisonous gases, which are always present in great 
amount. Do not be satisfied with a small opening for the 
ingress of fresh air ; but have two openings so the air in the 
room may circulate, taking care that the patient is not in a 
draft. Let her be well protected with warm coverings, and 
let these, as well as her personal clothing, be changed often. 
There is no good, but a positive harm, in allowing the bed- 
ding and patient's clothing to remain days and weeks with- 
out change. Let the patient be bathed often, and wiped or 
sponged off frequently, also, using a little soda in the water 
when the fever is high, and a little Bay-rum when there is 
less fever. 

Keep most visitors out of the room, and, if possible, 
away from the house. They often are a positive injury by 
disturbing needed rest, and exciting alarm by unwise though 
well-meant solicitude. 

The complications of this disease must be treated accord- 
ing to the peculiar conditions present, and the urgency of the 
symptoms, taking care not to compound the remedies, using 
one for a few hours or a day, singly, and then changing to 
another, which the complication seems to demand; the al- 
ternation which I have already mentioned being in the giv- 
ing of some antiseptic remedy in alternation with the one, 
especially indicated in that particular case. I am well aware 
that some homoeopathic physicians believe nothing in anti- 
septic treatment. So far as I can get at their objections to 
it, they are due to the fact that the term has been used by 
allopaths. Now, the reason for the faith which is in me is 



136 EATON ON DISEASES OF WOMEN. 

this : I believe that in the genuine case of puerperal peri- 
tonitis we have a blood poisoning which has a tendency 
to develop a pysemic condition of the blood and the conse- 
quent depression of nervous strength, which develops the 
Diathesis sen Infectio purulenta. Now, if this is not indica- 
tion enough for the giving of antiseptic remedies, then there 
are no indications for remedies. If we can not give anti- 
septics, neither can we use any kind of antidotes to poisons, 
and really an antiseptic is an antidote. If it can be ex- 
plained in any way which does not show its antidotal quali- 
ties, I am mistaken. 

I will digress just here to remark that in the treatment 
of Scarlatina Maligna, Diphtheria, and Epidemic Cerebro- 
spinal Meningitis, the need for antiseptics is equally great, 
and they prove as eminently beneficial. Without their use 
I would not take the responsibility of a case of either 
disease. 



HOMCEOPATHIC REMEDIES. 137 



CHAPTER XII. 

HOMCEOPA THIC REMEDIES. 

Desiring to condense as much as possible, we make a 
few suggestions regarding homoeopathic remedies. We do 
this, not to interfere with works upon Materia Medica, or 
Therapeutics, but that the reader may understand the opin- 
ions we entertain regarding them and their action on the 
system. Having used them now over ten years, and having 
previously graduated in allopathy, and practiced it for up- 
wards of a decade, we may, perhaps, offer some practical 
hints, and Ave say, unhesitatingly, that we consider homoeop- 
athic medication the more speedy and certain curative treat- 
ment, and we offer our understanding of its modus operandi. 

Attenuation. — This term has been so often confounded 
with potency that many have come to use the two terms as 
synonymous. This seems to me to be a grave error, and has 
led to much hard feeling on the subject of high and low 
potencies. 

As I understand Hahnemann, in his work on " Chronic 
Diseases," Vol. I, when specially teaching the preparation 
and nomenclature to be used, and as I find Jahr and Griiner's 
" Pharmacopoeia," as edited by Hempel, contains the same 
directions verbatim,* I must conclude there was in the early 
days of homoeopathy no idea that attenuation and potency 
were synonymous terms. There, we learn in plain English 
that the l c trituration is to be called the 100 th potency; 
that the 2 C attenuation is to be called the 10,000 ,h potency; 
and that the 3 C attenuation is to be called the 1,000,000 th 
potency. 

* Jahr and Griiner's Pharmacopoeia, by Chas. J. Hempel, pp. 4, 5, 6, and 
7. Also see tables on pp. 32, 33 r ibid. 



138 EATON ON DISEASES OF WOMEN. 

There is no chance to deny that these were the plain 
instructions of Hahnemann, and were quoted and appropriated 
as authority by Jahr and Griiner and Hempel. If these 
were the plain instructions of these fathers of homoeopathy, 
why should we not adhere to this nomenclature still ? If we 
did, we would hear no one speak of the 200 th potency, as 
there is no intimation in the works quoted that it is possi- 
ble to make any attenuation that should be called 200 th po- 
tency. The 30 th potency sometimes mentioned is probably 
intended to mean the 30 th attenuation. 

Trituration, attenuation, or dilution may be used as 
synonymous, as regards strength of medicine (trituration is 
attenuation with sugar of milk ; dilution is attenuation with 
alcohol), but potency is quite different, as I have shown 
from Hahnemann's own teachings. The 10,000 th potency, as I 
understand it (and as Hahnemann, Biichner, Griiner, and 
Hempel teach), indicates the 2 a attenuation on the centesi- 
mal scale, and the 4 th on the decimal scale. 

On account of the confusion of the terms potency and 
attenuation, much controversy has arisen in the profession as 
to the comparative merits of high and low potencies, which 
need not have existed had it been understood as Hahnemann 
taught in his work on "Chronic Diseases," just quoted, for 
all would have seen that the low trituration or dilution was 
the same as the high potency. After having given much 
time to the study of this matter I am fully convinced that 
Hahnemann never conceived of using remedies carried above 
the 30 th attenuation. The late lamented Dr. Carroll Dun- 
ham, of New York, carried up several remedies by dilution to 
the 200 th attenuation and claimed excellent effects from their 
use, as have several other excellent gentlemen. 

Drs. Swan and Finkie have claimed to make high dilu- 
tions, which they have called potencies, by a process of math- 
ematical calculation as to the attenuation produced by means 
of a certain amount of running water through a tube, in 



HOMOEOPATHIC remedies. 139 

which had been placed a small amount of medicine. Allowing 
the water to flow through the apparatus a certain number of 
hours, they have calculated that a certain attenuation was 
reached. They call the manufacture of remedies in this way 
the fluxion process. They, and many others, have reported 
cures with these high dilutions, the height of the potency 
of which is beyond human calculation. I will not deny the 
efficacy of these preparations, but will say they doubtless 
would have astonished Hahnemann had they been invented in 
his life- time; and if it is given to disembodied spirits to scan 
the acts of those below, what must be the emotion of Hahne- 
mann's spirit at the heights of fancy, imagination, and credulity 
reached by some of his disciples ! 

We have found, from our own experience, that from the 
2 X to the 6 X attenuations, or, if you please, from the one hun- 
dredth to the one millionth potencies (which is saying the 
same thing in different language), is the strength of medicine 
we find acts satisfactorily to us. Sometimes mother tinctures 
may act better ; sometimes it may be best to use potencies 
higher than the one millionth. Did we know the strength of 
the medicine used in the provings, we might better select the 
attenuation in treating cases of disease. The 3 C being suited 
to overcome symptoms indicated by provings with the first on 
the centesimal scale, while the first attenuation will overcome 
those provings, not toxicological, made with mother tinctures ; 
and mother tinctures are to be used in the treatment of those 
toxicological symptoms produced from poisonous doses of the 
remedy, when, of course, these symptoms are produced from 
disease. To overcome toxicological symptoms while the drug 
is still acting, of course, antidotal treatment is to be at once 
used. We feel convinced that the minute quantity of a given 
remedy produces on the system effects directly opposite to 
those produced by that remedy in large quantity. Hence, 
we have an explanation of the action of the properly selected 
homoeopathic remedy in any given disease. The remedy is 



140 EATON ON DISEASES OF WOMEN. 

selected because of the similarity of the symptoms we have 
in the case to those we know the remedy produces when 
given in considerably greater quantities than we use in the 
cure, the curative action being that of correcting these symp- 
toms, or, in other words, antagonizing them. The giving of a 
single remedy should be the rule, avoiding all alternation of 
remedies. I have known a physician to give five different 
remedies in the same case at the same time. Though he gave- 
them separately, the intervals were sometimes only ten min- 
utes, and the people found it impossible to keep the run of 
the remedies, and they changed physicians. Success never 
perched on that physician's banners, though he was educated 
in Germany, and talked learnedly of symptomatology, and 
ignored pathology. Every physician should seek to add 
something to the general stock of knowledge possessed by 
the profession. To do this it is important, at this age of the 
world, that we learn more of individual remedies, given 
singly, without alternation. 

The affinities which remedies possess for some particular 
parts of the body, or some particular organ of the body, can 
not be explained. We only can observe that it is so. We 
can no more tell why it is so than we can explain the law 
of gravitation or cohesion. We may observe the phenomena, 
but at last we have to say, God made it so. Why opium 
in minute doses is a stimulant, and in large ones is a seda- 
tive, can we explain, more than to assert, it is so? 

We learn, however, how to apply the remedy from our 
knowledge of its action. Homoeopathists use remedies for 
their primary action, or the action produced by the minute 
dose, while allopathists use remedies for their secondary 
action, in a large dose. Hahnemann discovered the law that 
the minute dose cured symptoms produced from disease 
which were characteristic of the remedy in large doses when 
given to the healthy man; hence we have a law 7 to guide us 
in the selection of a remedy, while the allopathist has none. 



HOMCEOPATHIC REMEDIES. 141 

Does any allopathist dare say our theories are unphilosophical 
or untenable ? Does he call a homoeopathic physician a quack 
because he has adopted an exclusive dogma, as he says? 
Then let him seek light in his own U. S. Dispensatory, where 
I found mine. Let him note the action of the small dose, and 
compare with the action of the large dose, as there laid down, 
and he will find enough to convince him of the universality 
of the law just mentioned. Then let him try in practice 
the application of this principle, and he will soon be able 
to declare that he, too, has found, not only joy in believing, 
but joy in practicing as well. 



142 EATON ON DISEASES OF WOMEN. 



CHAPTER XIII. 

INSTRUMENTS. 

The use of instruments has been sadly abused by the 
profession in the diagnosis and treatment of the Diseases of 
Women, to the extent of causing some thoughtful medical 
gentlemen to condemn their use in toto. We do not go this 
far, and still we are free to condemn many of the instruments 
in frequent use, especially most pessaries, and also the con- 
stant use of the speculum, uterine dilators, hysterotomes, etc. 
These instruments are occasionally useful; but probably not 
one-fourth as often as some have been in the habit of em- 
ploying them. We shall present only those instruments in 
this work which Ave can recommend (about eighty in num- 
ber), and we devote one chapter exclusively to their con- 
sideration, that the student may learn something of the uses 
and advantages of them, as well as be cautioned against 
their abuse. There is no work on Diseases of Women now 
published (1880) which, in our opinion, is fully up with the 
times in the matter of gynaecological instruments. This is 
strikingly evident in the matter of speculums, Cusco's being 
the best bi-valve published, and Sims' original speculum be- 
ing the best one presented as a retracting speculum — all ex- 
cept Richardson having omitted Dawson's improved Sims' 
speculum. (See Plate III.) 

This has one of the blades slit in two, and fixed with a 
screw so they may be separated, which is a great improve- 
ment in enabling us to bring into view the walls of the 
vagina or the cervix uteri. If we desire to use the instru- 
ment in its original form, we have but to screw the divided 
blade together and we have it. This instrument we ordi- 



Plate III 




SIMS' ORIGINAL SPECULUM. 




SIMS' FOLDING SPECULUM. 




DAWSON'S SIMS' IMPROVED SPECULUM. 



Plate IV. 




NELSON'S TRI-VALVE SPECULUM. 




FURGUSON'S MIRROR SPECULUM. 




WOCHER'S BI-VALVE SPECULUM. 



INSTRUMENTS. 143 

narily only use in operations for the treatment of vaginal fis- 
tulse, uterine polypi, or lacerations of the vagina, or cervix 
uteri. Whenever we do need to use a Sims' speculum the 
advantage of the divided blade is obvious, as it can be 
opened or closed during the operation at our pleasure. 

The speculum which we use for ordinary vaginal exami- 
nations, when they appear necessary, and for bringing the os 
and cervix uteri into view for ordinary treatment, is the 
bi-valve made by M. Wocher & Son, of this city. (See 
Plate IV.) 

This speculum combines the advantages of disco's han- 
dles, Higbee's screw on the side, and Taylor's blades, with 
the wide crest on the upper blade, to keep the flesh and hair 
of the labia out of the way. In our experience the advan- 
tage of having the upper blade shorter than the lower, as in 
Taylor's instrument, is very great. Taylor's speculum has 
to be opened with the screw, which is not so convenient as 
the handles of Cusco's, but Cusco's blades are of equal 
length, and it has not the wide crest on the upper blade. 
Wocher seems, in his instrument, to have combined the best 
parts of all the others, and left out their objectionable ones. 
The instruments are made of three sizes. 

Nelson's tri-valve speculum — Plate No. IV — is a very con- 
venient instrument, especially in those cases where the vagina 
is very large, loose, and flabby, as it distends the anterior 
walls of the vagina in a lateral direction. It is very good 
in office treatment, but can not be carried in the pocket so 
conveniently as Wocher's bi-valve, or Sims' folding speculum. 
(See Plate III.) 

Furguson's round mirror speculum is convenient to have at 
hand, to examine partially a suspected case of gonorrhoea 
or syphilis where we do not wish to introduce those we 
daily employ. The instrument is cheap, and is universally 
known. We also put them to a different use from that of 
making vaginal examinations. We employ them as vaginal 



144 EATON ON DISEASES OF WOMEN. 

dilators, and to admit the atmospheric air in cases of pro- 
lapsus, or a tendency to this displacement, having the patient 
recline, with the hips elevated, while it is inserted. (See 
chapter on Prolapsus Uteri.) 

Sims' vaginal dilator, Plate VI, is all right in cases 
of vaginismus, or a contracted vagina, first smearing the 
vagina with Belladonna ointment before its introduction; but 
in cases where we wish to dilate the vagina to admit 
atmospheric pressure direct to the uterus they are useless, 
as they are closed at one extremity. 

UTERINE SOUNDS. 

The uterine probe, or sound, is a useful instrument in 
diagnosis of uterine disease and displacement. It should 
always be used with skill and care. No considerable force 
should ever be used in its introduction, or any manipulations 
with it after it is introduced. Used carelessly, it may be a 
cause of much evil; but, if used with care, it is not inju- 
rious. 

Simpson's uterine sound has been much used, but it 
is too stiff. The steel sound, which can be easily N bent with 
the fingers, is to be preferred, as it is often of great advan- 
tage to be able to change its curve. The steel sound should 
not be larger just at the point (see Plate V), as uterine 
sounds are usually made ; neither should it be sharp or more 
pointed at the end, but should be of uniform size* for four 
or five inches from its extremity. It is well to have notches 
in the sound, at intervals of one-half inch, that we may 
note more readily the length of the uterus. Dr. Skene has 
invented a very good sound for measuring the length of the 
uterine cavity (see Plate V). It has a slide which is drawn 
back when the sound is introduced, and, when fully inserted, 
the slide is pushed up against the os, and we can determine 
by it just how far the sound has entered the womb. 

Hard rubber uterine sounds should never be used unless 



Plate V. 



TlkWANN&CO 



Fij.l 

SKENE'S SOUND. 




Plate VI. 




SIMS' VAGINAL DILATOR. 




cc 








dl 




H 




co 








£ 






H 




i 




Q 




ij 




2 






cc 


< 






p 


cr; 




• 


J 


w 






o 


P 


2 1 1 1 i 


ffi 


J 


s x 11 ! 


o 


o W 


PC 


n 1 

s Ml 


p 
p 


DJ 


3 ! 


w 


K 


** II 


w 


£ 


w 1 

a 1 


2 
Cfl 


O 


n Ij 


Z 


g 


" 


o 


LO 


p 


I- H 


P 


1 


i : < 


fe 


II | 




O 


J 




Q 


1 




O 






DC 




H 




W 




S 









INSTR UMEN TS. 145 

great care is taken to warm them by putting them in warm 
water. When cold they are liable to break, even from slight 
pressure. 

Caution. — The physician should always be sure pregnancy 
does not exist before he attempts the introduction of the 
uterine sound. 

Cellulitis also contra-indicates its employment, even for 
purposes of diagnosis. The use of the sound, or even any 
considerable manipulation with the ringer, in cases of cellu- 
litis, is very likely to awaken an increase of the inflammation. 

The use of the sound gives us information of the pres- 
ence of stenosis of the uterus, tenderness and flexions of 
the organ, the size and attachment of fibrous polypi, and 
some information regarding intra-mural fibroids, etc., etc. 

HYSTEROTOMIES. 

The hysterotome is an instrument for incising the interior 
of the cervical canal. It is occasionally needed in stenosis 
of the cervix; Its use must, in these cases, be followed by 
the daily introduction of the bougie smeared with vaseline to 
prevent the adhesion of the cut surfaces, and the consequent 
diminution of the size of the cervical canal. I prefer Simp- 
son's or White's. (See Plate V.) 

eaton's needle holder. 

In addition to the straight needle holder already mentioned 
for sewing up longitudinal lacerations and fistulre of the vagina, 
the gynaecologist needs an instrument for placing sutures in 
a transverse laceration or fistula. This is accomplished with 
my needle holder, as can be readily seen from the cut, Plate 
VI. It enables us to insert the needle into the vaginal tis- 
sues from above downwards with the same facility with 
which we use the straight holder in stitching from side to 
side, for which purpose my holder may also be used by 

grasping the needle further down on the blades. 

10 



146 EATON ON DISEASES OF WOMEN. 

To fasten or twist the wires after the sutures are placed 
in a vaginal laceration, or either form of vaginal fistulse, we 
use our wire holder and twister. (See cut of wire holder 
and twister, Pate VI.) Pass the ends of the wire through 
the two holes in the end of the holder, make traction on the 
wires with one hand, and slide the instrument up to the 
lacerated tissues with the other — this approximates their 
edges. We then give the instrument two or three turns, with 
the fingers holding if, and the wire is twisted and the suture 
secured. We now slip the twister off the wires and cut 




Fig. No. 6. — Long Curved Scissors. 



them with the long, curved scissors. This instrument makes 
the twisting of the wires high up in the vagina a very easy 
operation. 

We present Palmer's uterine dilator (see Plate VIII), 
not to advocate its frequent use, but because rapid dilatation 
of the cervical canal of the uterus is sometimes necessary ; 
and when so, we prefer to use "Palmer's Uterine Dilator." 
With it we can make the dilatation as gradual as we please, 
and still, with the aid of the screw in the handle, maintain 
an even and regular expansion, and increase or diminish it at 
will. The blades which are inserted into the os are slender 
and slightly curved, and still not too pointed nor too blunt, 
as are some others. 

Rapid dilatation is most frequently called for in cases 
where women have passed a piece of a hard rubber probe 
or a stick into the uterus and broken it off; or have passed 
in short pieces of whalebone and lost hold of them. I have 
been called to remove foreign substances of this character 
from the uterus in several instances where dilatation of the 



Plate VII. 




BABCOCK'S SUPPORTER. 





Plate VIII. 





INS 7 'A' UMEN TS. 147 

os uteri internum, as well as externum, had to be ac- 
complished rapidly. 

Occasionally its use facilitates the getting at an internal 
uterine polypus, where we have but a short time at com- 
mand. Very rapid dilatation is in most other cases objec- 
tionable, in that it lacerates the tissues, and, in their healing, 
causes somewhat of a cicatrix, which interferes with the re- 
laxation and dilatation of the os in labor subsequently, and 
may cause stenosis, or even atresia of the cervical canal, 
and prevent impregnation, arresting the menstrual flow, and 
producing hsematometra. 

Hence, whenever rapid dilatation is used, care should be 
taken to keep up some degree of expansion till the tissues 
are healed. Passing into the cervix every two days a bougie 
smeared with Vaseline, is a good way to accomplish this. 

PERINEUM NEEDLES. 

In operating for lacerated perineum it is most convenient 
to use Peaslee's improved perineum needles and holder 
shown in Plate VI, whether we wish to use the quill or ordi- 
nary interrupted suture. The needles fasten into the han- 
dle with a thumb-screw, and the eye of the needle is 
near the point as shown in the cut. This is much more 
convenient than having the needle screw into the handle. 
Having the three needles threaded before commencing the 
operation there is no delay in placing the sutures, as one 
needle can be taken from the handle and another, all 
threaded, inserted almost instantly. (See the old form, Plate 
XI.) In an emergency the largest sized surgeon's curved 
needles may be used to place interrupted sutures in the lac- 
erated perineum; but the regular perineum needle is much 
to be preferred, when Ave can have it, and in placing the 
quill sutures this, or a similar needle, is absolutely neces- 
sary. (See chapter on Lacerated Perineum.) 



148 EA TON ON DISEASES OF WOMEN. 

Pease's staphylorraphy needle represented by Fig. No. 7, 
was invented by Gr. M. Pease, M. D., of San Francisco. 




Fig. No. 8.— Pease's Needle. 

This needle is described in the proceedings of the Pacific 
Homoeopathic Medical Society, 1874-6, and in the proceed- 
ings of the American Institute, 1871. The needle is useful 
in operations for vaginal fistulse, as well as cleft palate. 
The silver wire is propelled through the needle (which is 
conula shaped, with the eye near the point), by means of 
the little wheel on the side of the handle. 

PESSARIES. 

I am well aware that medical gentlemen of high standing 
advocate the use of pessaries, even those of hard rubber ; but 
they have to acknowledge that, unless used with skill and 
judgment, they may do much harm, and that the physician 
must have experience, as well as a mechanical talent, to ad- 
just and select them properly (see Emmet's "Prin. and Prac. 
of Gynaecology," one of the most prominent of the old school 
books, which acknowledges all this, and still advocates their 
use very strongly). Now, how many medical men have skill, 
judgment, experience, and mechanical talent ? Can we say 
that more than one in ten have all these ? If not, then must 
we recommend the other nine- tenths to use pessaries indis- 
criminately to the injury of their patients ? 

Simply introducing a pessary into the vagina is not 
using it with skill, even if it be so small as to cause no 
pain. Besides, the use of them, as has been the custom, and 
the theory regarding their beneficial effects, have been en- 



INSTR UMENTS. 



149 



tirely erroneous and founded upon . erroneous ideas of the 
etiology of displacements, as we will more fully show in the 
chapters upon Displacements of the Uterus. 

While we condemn pessaries from a conviction of the in- 
jury they have done and a belief that they may, in nearly all 
cases, be discarded, I am aware that, in some few cases, 
where we can not mannge the patient or obtain her co-oper- 
ation, and where a patient is obliged to be con- 
tinuously traveling or standing, and in the case 
of old women, where we can not hope for a 
cure, some form of soft pessary may be ad- 
visable. In these exceptional cases we use 
the inflatable rubber pessary or the elastic 
ring. The abdominal supporter must always Ring pessary. 
be used in connection with even these pessaries, as otherwise 
the uterus is placed between the pressure of the bowels from 




Fig. No. 8.— Elastic 




Fig. No. 9. — Elastic Rubber Pessary, with Tube and Stop-cock. 



above and the pessary from below, and injury readily results 
in the way of flexions of the uterus, or inflammation of this 
organ, the cellular tissue, or the ovaries. 

Before inserting a pessary of any kind, the bladder and 
bowels should be evacuated, and the patient should recline 
with her hips elevated, with the body low, and the uterus 
should be replaced before the pessary is introduced into the 
vagina. Then an abdominal supporter should be applied 
before the patient rises. The pessary should be removed and 
cleansed at least once a week. It should not be worn, in any 
case, but a few weeks, as a rule. 

The Babcock Supporter holds the womb up in a cup- 



150 



EATON ON DISEASES OF WOMEN. 




shaped instrument. (See Plate VII.) It is objectionable in 
retaining the secretions and in being too stiff. The cup is sup- 
ported by a steel shaft, which is held in position by a belt 
around the lower portion of the abdomen. The shaft of steel 
may be moulded to the form somewhat. In some old women 

suffering with prolapse this instrument 
is worn with comfort ; but ordinarily 
it is found that it causes pain and irri- 
tation. It will sometimes answer a 
good purpose where the atonic condi- 
tion of the system is marked, and 
where we can not' do better. The in- 
strument, if used, should be often re- 
moved and cleansed. The different 

Fig. No. 10 — M'Intosh's Uterine 

supporter. shaped cups make it adapted to varie- 

ties in the shape and location of the os uteri. (See Plate 
VII.) M'Intosh's Uterine Supporter and Abdominal Sup- 
porter Combined is sometimes found useful ; but internal sup- 
port is to be avoided in all cases where it is possible to do so. 
(See Treatment of Prolapsus Uteri.) 

SPONGE TENTS. 

The uses of sponge tents we mention in connection with the 
conditions and diseases for which we recommend them. They 
should be solid and smooth, and fye 
furnished with a strong cord to aid 
in their removal; and should have 
an opening in their larger end to 
insert the end of the sponge holder, 
which it is advisable to use in the 
introduction of the sponge into the 
cervical canal. The best of the 
sponge tents now in use are carbolized in their manufacture ; 
still it is well to dip them into carbolized glycerine just 
before we insert them. 




Fig. No. 11— Sponge Tent. 



INSTR I T ME NTS. 151 

Dr. Emmet, of New York, has invented a sponge dilator, 
as he calls it, which is advantageous in some instances. The 
advantage of this dilator (see Plate IX) is that with it the 
sponge does not become imbedded in the tissues of the 
cervix as when the sponge is directly applied. Dr. Em- 
met * describes the instrument and its uses in the following 
language : 

" Through a disk of hard rubber passes a brass tube, which 
is perforated by a number of small holes at the upper portion, 
and is open at each extremity. This tube is passed through 
the center of a sponge tent of suitable size. The tent is then 
covered by a thin India rubber cot or bag, and its mouth 
stretched over the edges of the disk. The free edge of the cot, 
which has been drawn over the disk, is then secured, com- 
pressed between the under side of the disk and the brass plate 
A B, on screwing up the latter sufficiently. The brass disk A 
B has attached to it on side at B a knob which can be grasped 
by a pair of forceps, the limbs of which are closed by sliding 
forward the canula E. When the knob B is held by the 
forceps, a ball-and-socket joint is formed, which will admit of 
any motion within the radius of a sphere. To the bulb at C 
is attached a piece of India, rubber tubing, a foot or more in 
length, through which water is introduced for swelling up the 
tent, and at the end of the tube is a stop-cock. To the other 
side of the stop-cock a Davidson syringe may be joined, or 
what I have found to answer better, a thin India rubber bag, 
such as are used for pessaries, with tube and stop-cock. The 
dilator is introduced by steadying the cervix with a tenaculum 
in one hand ; and by holding the forceps and tubing in the other 
the proper direction can be given to the instrument. When 
it has been introduced within the canal to the proper depth, 
a small amount of water is to be thrown in before removing 
the forceps. As the tube occupying the center of the sponge 
* Emmet's "Principles and Practice of Gynaecology," page 32. 



152 EATON ON DISEASES OF WOMEN. 

is open at its extremity and its sides perforated, the water 
will make its exit at the upper portion, and dilatation will 
extend from above downward, so that the instrument can not 
slip out. Enough of the sponge is dilated in a few moments 
for the purpose of retention, so that the forceps may then be 
removed by sliding back the canula. I direct the patient to 
lie in bed on her back, and to place on the abdomen the air 
bag, which has been filled with water, from Avhich a sufficient 
supply to fully dilate the sponge is made to flow by occa- 
sionally compressing the bag with the hnnd. 

"I generally leave the dilator in place for some twelve 
hours, unless there should exist some special reason for more 
rapid dilatation. The instrument is easily withdrawn by 
placing the patient on her back, removing the bag, and turn- 
ing the stop-cock for the escape of water from the sponge. 
The forceps can be passed along the index finger into the 
vagina and attached to the instrument, when it can be with- 
drawn, guarding against displacing the uterus by holding the 
finger against the cervix. 

"The chief advantage of this dilator is that it greatly 
reduces the risk of blood poisoning, and if we could dispense 
with the unprotected sponge in the first instance this danger 
would be entirely obviated. Fortunately, when this does 
occur, it is seldom from the use of a, single tent; and, if the 
precaution be taken, which I always insist upon, to wash out 
the canal thoroughly whenever a, tent is removed, we will 
greatly lessen the risk. It is also a great advantage gained 
from the use of the dilator that the mucous membrane is not 
injured, and consequently we have no bleeding from the canal 
when it is removed. 

"The disadvantages are, that we can seldom dilate to the 
same extent as can be done by the tent alone. The resist- 
ance offered by the uterine wall will yield to the steady 
pressure of the sponge, but the elasticity of the India-rubber 



Plate IX. 




TIEMANN & CCVS ASPIRATOR. 




EMMET'S SPONGE DILATOR. 



INSTR UMENTS. 153 

bag is persistent, and will, to some extent, counteract the 
force of the sponge. Consequently, we are obliged to use a 
cot much larger than the sponge, which will occupy an 
additional space, and, therefore, makes it necessary that the 
canal should be partially dilated before the dilator can be 
introduced. 

" On the other hand, this dilator has the advantage that 
the force can not be concentrated at any one point, but 
must be exerted throughout, as the sponge gradually dilates. 
I have used the instrument several times for rapid dilation, 
and it ansAvers the purpose, but, unless there should be a 
necessity for doing so, the more gradual process is to be 
recommended, as attended with less risk in surgical pro- 
cedures; but the contrary is true in obstetrical practice. 
For rapid dilatation, however, it has no advantage over any 
other instrument of the kind, as at first the water escapes 
outside of the sponge when rapidly thrown in, and becomes 
the dilating power, but, as soon as the sponge has had time 
to expand, it absorbs the water, and the pressure then 
becomes uniform." 

ASPIRATORS. 

Aspirators are now used very extensively. They enable 
us to evacuate effusions into the pleura, and even in the 
pericardium. In gynaecological practice they are used to 
diagnose the nature of an ovarian cyst, and differentiate 
it from the cyst of the broad ligament in some cases. With 
it we may sometimes evacuate a pelvic abscess. The wound 
made by the introduction of the aspirating needle is so 
small that little or no irritation in the tissues is left after 
its use. 

I copy the description of Dieulafoy's instrument, given 
by Dr. Jas. L. Little, of New York (see Plate X). Tie- 
maim & Co., of New York, make another very good instru- 
ment also (see Plate IX). I .have had some trouble in 
keeping the stopper in the jar of this instrument air-tight. 



154 EATON ON DISEASES OF WOMEN. 

The Tiomann instrument is so simple that it needs no special 
description : 

" Dieulafoy's aspirator consists of a strong glass cylinder, 
about seven inches in height, two inches in diameter, and 
of a capacity of one hundred and forty-five grammes, equal 
to nearly four fluid ounces. In front, upon a nickel-plated 
German silver casing, which envelops the cylinder in part, 
is a graduated scale that reads off in grammes the amount 
of fluid contents — the gramme here being not a measure of 
weight, but of capacity (each gramme being equal to the 
space occupied by a cubic centimeter of water at a tempera- 
ture of 39.2° Fahr.). Above, the piston is raised by means 
of a rack and pinion motion, worked by the handle, and kept 
from slipping by the spring. At the bottom are two stop- 
cocks that may be opened or shut as needed. Upon these 
are fitted two strong, yet perfectly flexible, rubber tubes. 
Upon the one may be seen a perforated aspirator needle, 
while the other is dipping into a receiving bowl. In the 
tube which holds the needle is inserted a piece of glass 
tubing, near the needle extremity (not shown in the cut), 
that indicates whether the material to be evacuated is pass- 
ing through the tube. The other tube is to allow discharge 
of the cylinder's contents. 

" The capillary tubes, trocars, or aspirator needles are seen 
on Plate X. They are of various lengths, and vary greatly 
in their diameters, the smallest being one-third of a milli- 
meter (the size of the ordinary hyperdermic needle), while 
the largest is about one and one-half millimeters, in diameter. 

"It is well to have also two or three small canulas and 
trocars on hand, their handles detachable, so that when 
introduced, and the trocar withdrawn, they may be attached 
to the rubber tubing. 

"To use the instrument, attach to the two taps the two 
pieces of rubber tubing, and to the one tube attach the 
needle to be used. The other tube should be placed in a 



Plate X. 




DIEULAFOY'3 ASPIRATOR. 




VULSELLUM FORCEPS. 



- —-___-=-__ -j ^zt G.T JEM A NM &C0 " I 




EXPLORING TROCAR AND CASE. 



INS 7 'A' UMEN TS. 155 

basin. Having every thing in readiness, close both stop- 
cocks, turn the handle, thus raising the piston to its fullest 
extent, and creating a vacuum. Next insert your aspirator 
needle with a gentle rotary motion into the cavity to be 
aspirated, turn the stop-cock, and the fluid will be seen to 
pass through the glass tubing and up into the instrument. 
When this is filled, close the stop-cock, and open the oppo- 
site one, pull out the spring, and push the piston down. 
The fluid is thus driven out through the tube into the bowl 
or bottle ready to receive it. If there be more fluid present 
turn both stop-cocks, and, again raising the piston, proceed 
in the same manner as before. 

" In using the instrument attention to the following prac- 
tical points is necessary : 

" 1st. Before using, assure yourself that the instrument 
is in perfect working order; that there is neither stoppage, 
leakage, or difficulty in manipulating, or stop-cocks hard 
to turn. 

"2d. The needles or trocars, which should be perfect, 
should be oiled before attempting their introduction. 

" 3d. Slow, steady, even pressure, with rotation, the 
needle being held between the thumb and index finger, will 
be found to accomplish the result with as little pain and 
injury to the tissues as is possible. The skin should be 
slightly nicked with a scalpel before inserting the needle. 
Local anaesthesia may be used if thought desirable. 

"4th. In removing the trocar, do so slowly, aspiration 
being continued meanwhile, to prevent the escape into the 
tissues of any fluid that may be in the trocar. Bear this 
in mind, especially in aspirating the peritonaeum. 

"5th. After using the instrument each time, carefully 
wash it out, and its attachments, by drawing carbolized or 
chlorinated water several times, with the cylinder, through 
the tube attached to taps, forcing the same out through tube 
at taps, after the manner of aspiration and discharge of fluid. 



156 EATON ON DISEASES OF WOMEN. 

"6th. The piston may be kept in good condition by 
occasionally unscrewing the head of the cylinder, and pour- 
ing in about half an ounce of sweet oil. 

" 7th. Always keep wires through the needles when not 
in use/' 

Lentis' Modified Inhaler — (See Plate XI) — needs no 
explanation. It is convenient where we desire to use 
anaesthetics. 

Little's Antiseptic Spray Apparatus — Consists of a spirit 
lamp placed underneath a copper boiler, as seen in 'Plate XI. 
The antiseptic or disinfectant is placed in the glass jar at 
the side, and the steam generated in the boiler forces the 
liquid in the jar up through the glass tube inserted into it 
by means of the vacuum produced, and a fine spray is made 
by the steam coining out through the horizontal tube. 

ABDOMINAL SUPPORTERS. 

Appliances for holding up the abdominal viscera, from 
pressing down unduly upon the pelvic organs, are termed 
abdominal supporters. They have been so poorly adjusted, 
or have been so poorly made, in some instances, as to be 
designated by a contemporary as abominable supporters. 
And when improperly used, or constructed improperly, they 
are abominable. Must we condemn them in toto because 
they are capable of doing injury when improperly used? 
Under this ruling, I believe, every surgical, obstetrical, 
and gynaecological instrument might be condemned and 
called hard names. Fire or water may destroy life when 
improperly used; on the contrary, they may preserve it, 
when properly made use of. Shall we banish fire, water, 
surgical, obstetrical, and gynaecological instruments because, 
when improperly used, harm may result? Or shall we use 
them properly, and obtain the good results which follow their 
intelligent use ? 

The abdominal band, when applied to compress the~ ab- 



Plate XI. 





LENTE'S MODIFIED INHALER. 



LITTLE'S ANTISEPTIC SPRAY 

APPARATUS. 




ASHTON'S PERINEUM NEEDLE. 



/Z 



PEASLEE'S PERINEUM NEEDLES. 




NELATON'S TUMOR FORCEPS 



Plate XII. 




SILK ELASTIC ABDOMINAL SUPPORTER. 




THE OLD LONDON ABDOMINAL SUPPORTER. 




EATON'S IMPROVED LONDON ABDOMINAL SUPPORTER. 



INSTRUMENTS. 157 

domen around the waist, must be injurious, by pressing the 
abdominal viscera down into or towards the pelvis. On the 
contrary, if applied to the lowest part of the abdomen tightly 
and made less tight above, it lifts and holds up the abdom- 
inal viscera, especially when the patient is erect. (In the 
reclining posture no abdominal support is ever required.) 

Twenty and more years of practical experience in the 
use of abdominal supporters gives me stronger faith in their 
beneficial effect, than in any previous time of my life; and 
I have always been an advocate of their proper use. Their 
range of application is in those cases where there is tender- 
ness, inflammation, or displacement of the pelvic organs, 
cystitis, metritis, ovaritis, versions, flexions, or prolapse of 
the uterus, all of which require that the weight of the intes- 
tines be kept from pressing down into the pelvis. This can, 
of course, be done by maintaining the horizontal position, 
but it is usually desirable that our patient take some exer- 
cise, which she can not do without injury in these com- 
plaints, unless some means are used to maintain the intes- 
tines in situ, or even lift them above their natural position 
slightly. 

I am not particular about any special make of supporter ; 
we only insist upon the principle being carried out. Some- 
times extemporized bands are made by patients themselves, 
or their friends, which support the abdomen quite well. Dim- 
can Bros., Chicago, have a very good supporter of this kind, 
which needs, however, to be improved by inserting strong, 
elastic straps. Ordinarily, however, among a well-to-do class, 
it is best to buy for them a band made by the regular instru- 
ment-maker. The band needs to be a little firm in front and 
back, to prevent wrinkling, and must be elastic in part that 
it may give somewhat, and not bind the hips, as the lower 
part of the band, to be of service, must come below the crest 
of the ilium. 

The supporter which we commonly use has two elastic 



158 EATON ON DISEASES OE WOMEN. 

straps on the side, reaching from the front to the back piece, 
one of which I place below, and the other above the crest of the 
ilium. Leaving the upper one a little loose, I make the lower 
one quite tight, having the front stiffened part bent inwards, 
to fit the shape of the abdomen. In cases of small abdomens, 
we have to apply a pad underneath the band in front, so as 
to get a better upward pressure with the supporter. (See 
Plate XII.) This is a modification of the London supporter, 
which I have had made by the Messrs. Wocher, of this city. 
The London supporter (see Plate XII) is objectionable in 
that it is more difficult to obtain the tightness of the band at 
its lower part, where it is needed, the straps being too near 
together, and the lower one too far above the lower part of 
the front piece of the supporter. Sometimes, in case of pen- 
dulous abdomens, we have the entire band made of silk elas- 
tic to fit the shape of the lower abdomen, and buckled on so 
as to be tightest in its lowest part. (See Plate XII.) We 
could not get along without the use of some support for the 
abdominal viscera. 

Fitch's supporter made with springs of steel, which are 
placed over the crest of the ilium and rest against two pads 
at the back, and in front against a stiff piece well padded, is 
made too small, and the steel pieces are too stiff; conse- 
quently, it has gone into disuse. It might, however, be made 
a useful instrument by correcting the objectionable parts of it, 
which I have mentioned. 

The woman affected with uterine complaints is more uni- 
versally relieved by the use of a properly applied abdominal 
supporter than by any one means within our knowledge. The 
physician using abdominal supporters intelligently will receive 
more thanks and gratitude for them than for any other service 
he can render, for the reason that relief is so apparent. 

Objections. — Objections have been urged to their use that 
they do not fulfill the indications. I reply, then they were 
carelessly or ignorantly applied. 



Plate XIII. 




HALF CURVED SUTURE NEEDLES 



BOZEMAN'S TENACULUM. 




riEMA NN —CO. 




CALLENDER'S DRAINAGE CANULA. 





SELF-RETAINING 
CATHETER. 



FULL CURVED SUTURE NEEDLES. 



Plate XIV. 





IiVS TR UMENTS. 159 

It has been objected to the use of abdominal supporters, 
that the patient becomes accustomed to them, and after awhile 
can not do without them. We reply, this has not been our 
experience. That they have usually to be worn Cor several 
months is true, as regards chronic cases, but is not true in 
recent cases requiring their use. 

UTERINE ELEVATORS. 

Various instruments have been devised to replace flexions 
and versions of the womb. Sims' elevator (see Plate XIV) 
is a very <rood instrument in retro-version, but can not be 
readily used in retro-flexion, ante-version, or anteflexion. 
Elliott's instrument (see also Plate XIV) is adapted to all 
displacements. By means of a screw in the handle the 
point of the instrument is moved from side to side, or 
extended in a direct line ; hence making it easy of introduc- 
tion; and, when introduced, w T e have but to turn the screw 
in the handle to bend the other end of the elevator in the 
opposite direction, and thereby correct the flexion we wish to 
rectify. In versions of the uterus it is equally serviceable. 

ELECTRICAL BATTERIES. 

There is no end to the various styles of electrical bat- 
teries. Electricity is the same in whatever form of battery 
we develop it from chemical decomposition. Friction batter- 
ies are out of date as therapeutic agents, and we will not 
describe or recommend them. The object to be obtained 
with the use of electricity is a tonic effect upon the nerves, 
and for this purpose must always be used in a mild current 
(an exception being made in cases of paralysis, where it may 
be used quite strong). 

Severe treatment with electricity I think as unwise and 
injurious as large doses of drugs, and equally to be avoided. 
Immense batteries we do not think necessary, unless the 



160 



EA TON ON DISEASES OF WOMEN. 



physician desires to add to the furniture in his office in 
this way. 

In the chapter on amenarrhcea, page 38, may be found 
a cut of the combination battery, which I think as large as 

there is any need of in the treat- 
ment of the diseases of women. In 
chapter on sub-involution is a cut 
of a medium -sized battery, which 
is as large as the physician ordi- 
narily requires. I prefer the Far- 
adic or interrupted current. The 
automatic rheotome attached to the 
combination battery makes it every 
thing that could be desired. For 
family use the small 
instrument shown in 
the annexed cut is 
very desirable, and 
obviates the neces- 
sity for the physician to take his from the 

Office. Fig. No. 13-Case of 

A very neat case of electrolysis needles KLKtML ™ ^™. 
is put up by Flemming & Talbot. It contains six needles 
and conducting cords. 

PEDICLE CLAMPS. 




ABLANC, 

Fig. No. 12.— Faradic Battery. 




Although we do not believe in the use of pedicle clamps 
as a rule, we present cuts of some, that the student may be- 
come familiar with them, if he desires to put them in use. 
(See Plate XV; also, chapter on "Ovariotomy.") 

The Spencer Wells clamp has had many friends. With it 
a very powerful, but quite unnecessary, pressure can be 
exerted upon the pedicle by means of the handles, which can 
afterwards be removed. For myself I prefer the Dawson 
clamp. (See " Ovariotomy.") 



Plate XV. 




THOMAS' CLAMP. 





SPENCER WELLS' NEW CLAMP. 



SPENCER WELLS' NEW CLAMP. 
(Detached from the handles.) 




SPENCER WELLS' NEW CLAMP. 



SPENCER WELLS' 
ORIGINAL CLAMP 



INS 'J 'A' UMEN 1 'S. 



101 



SPHYGMOGRAPHS. 

The sphygmograph is an ingenious instrument with which 
to note the varieties of pulse, which is often of importance 
in making both the diagnosis and prognosis of disease. 

The instrument is so 
delicately constructed 
that the slightest irregu- 
larity of the pulse is 
noted by it, and made a 
matter of record, as is 
seen in the sliding piece 
of smoked glass seen in 
the top of the cut. By 
means of a spring in 
the wheel this smoked 
piece of glass is pro- 
pelled evenly, while an 
index needle traces the 
throbbing of the pulse 
with exactness. With 
its use we can discover 
an irregularity of the 
Fig. No. 14.— Sphygmograth. pulse which we could not 

detect by the sense of feeling. This may give us important 
information regarding the heart's action, as well as the con- 
dition of the blood vessels, and in some instances may throw 

light upon the diagnosis of nervous diseases also. 

11 




162 



EATON ON DISEASES OF WOMEN 



CHAPTER XIV. 



INDURATION AND HYPERTROPHY OF THE CERVIX UTERI— 
VAGINISMUS AND DYSPAREUNIA. 



Induration of the cervix signifies a hardening of the neck 
of the uterus, giving it the feel of gristle, and sometimes 
much like bone, while hypertrophy of the cervix signifies an 
enlargement or elongation. Hypertrophy may affect the whole 
cervix, or be confined to one lip of the os. It may consist 
of soft, spongy tissue, or be associated with induration ; 

hence we may have hypertrophy 
and induration in the same case. 
Induration exists in all stages, 
from the very slight, confined to 
even a part of one lip, or affecting 
the whole of one lip or the whole 
cervix. 

Hypertrophy may exist in 
small or great degree. It may 
have the effect of causing an 
enlargement of the cervix lat- 
erally, only (see Fig. 15) giving 
greatly increased thickness to 
the walls of the cervix, and gen- 
erally accompanied with a cor- 
responding enlargement of the 
os uteri. In other cases the hypertrophy produces an elonga- 
tion of the cervix, without any considerable increase in its 
diameter. On introducing the uterine sound, in some cases we 
find the cervical and uterine cavity to measure from four 
to six inches. In women who have borne children we 




Fig. No. 15.— Sub-involution and Hyper 
trophy of the cervix. 



INDURATION AND HYPERTROPHY. 163 

should have a measurement of at least four inches in the 
cervix and uterus, or we could not denominate the case 
one of hypertrophy, however much the cervix projected 
downwards, even to the extent of appearing externally. It 
would be a case of procidentia and not hypertrophy, unless the 
measurement of the uterine canal showed considerable in- 
crease above what is normal ; and, further,, simply an increase 
in the length of the uterine cavity, with prolapse, will not 
indicate hypertrophy of the cervix positively, for the gravid 
womb and a condition of sub-involution would present this 
condition of elongation. (Of course, the reader will under- 
stand the sound is never to be introduced if there is any 
probability of pregnancy.) We must be sure that the elon- 
gation is due to increase of length in the cervix. The cer- 
vix uteri is firm in structure, and elongation must be due to 
development of tissue in this part, or the case is not hyper- 
trophy of the cervix. 

It is something very common that medical men have 
strange ideas, not to say hallucinations and hobbies, on some 
particular subject, while very correct on all others. I sup- 
pose I, too, have mine, but as we can not see our own, to 
some one else must be assigned the duty of pointing mine 
out, while I feel it my duty to call attention to a peculiar 
idea advanced in Prof. Emmet's excellent work,* pages 482- 3, 
He says : 

"Among sterile and unmarried women cases occasionally 
come under observation which are supposed to be instances 
of elongation of the cervix, when the disease is not in the 
cervix proper; and, instead of there being an enlargement of 
this portion, actual atrophy is the rule. Some change in the 
character of the tissues forming the supra-vaginal portion of 
the uterus takes place, of the precise character of which I 
must confess my ignorance. It is to be hoped that the 
pathologist will be able to throw sufficient light upon the 

* " Prin. and Prac. Gynaecology." 



164 EATON ON DISEASES OF WOMEN. 

subject to indicate the proper mode of treatment. In such 
a case the uterine body becomes elongated when the woman 
stands, and while the fundus stands stationary, the tissues 
below stretch out, as if formed of soft putty, becoming elon- 
gated by their own weight. 

"In this prolapse the uterine neck is pushed forward in 
the vagina, and frequently beyond the outlet, and the supra- 
vaginal portion of the uterus appears with a covering of the 
vagina presenting the appearance of an elongated cervix. 
The probe may be passed in such a case five or six inches, 
or a blunt sound may be introduced to the fundus, when, if 
the cervix be drawn with a tenaculum along the staff to the 
handle, the depth of the canal is shown to be eight or nine 
inches. If we next place the patient on the knees and 
elbows, for examination, the change brought about will be a 
remarkable one. The whole of this elongation will disap- 
pear, and the uterus will be found to be but two and one- 
half inches in depth. In this position the uterus seems to 
shut up, falling together, as would an old worn-out spy-glass, 
if held upright." 

Now, I have never seen a case like the one above de- 
scribed, nor have I ever before heard or read of such a con- 
dition in the married, unmarried, barren, fruitful, or other- 
wise. The affection may be peculiar to New York; I can 
not say. Whenever I have drawn down the uterus, I have 
found that its interior measured about the same as before. I 
would as soon expect to elongate a finger by making traction 
upon it, as the uterus by drawing down the cervix. 

Dr. Emmet asserts that the fundus remains stationary in 
these cases, and that traction upon the cervix with a tenac- 
ulum, or even its own weight, stretches the tissues of the 
uterus from two and a half to eight or nine inches. This 
is a pretty good showing for the strength of the tenaculum, 
the firmness of the attachment of the fundus, or the elastic- 
ity of the uterine tissues. 



INDURATION AND HYPERTROPHY. 165 

My opinion is, that such a condition of the uterine 
tissue as this will not often be met with, and would show — 
well, as Dr. Emmet does not attempt to explain, I will not. 
As I freely accord to him the honor of being the discoverer 
of this condition, I will leave to him to explain what it in- 
dicates. The student (especially in New York), will, how- 
ever, be on his guard, and not amputate an apparently elon- 
gated cervix till he has taken care to ascertain if it be one 
of the spy-glass variety described by Prof. Emmet, as just 
quoted. Ordinarily, the student will find that the uterus is 
firm, and not elastic ; that when he draws down the cervix, 
the fundus comes along also, even if pushed up with the 
sound, while traction on the cervix is being made. 

Etiology and Pathology* 

Inflammation is an important agent in the production of 
hypertrophy or induration of the cervix, in most cases, if it 
is not, in every case, the prime cause. 

The causes of the inflammation are various. They may 
be cold, excessive coitus, masturbation, or traumatic injury in 
confinement, or otherwise. The lateral hypertrophy and in- 
duration I have found most common in women who have 
borne children — generally, though not always, caused from 
lacerations of the cervix in confinement — while the longitu- 
dinal hypertrophy is mainly found in the barren or unmarried, 
this condition being a probable cause of barrenness, some 
cases being congenital. 

The process of development of hypertrophy is this : 
Owing to some of the causes enumerated, there is an excess- 
ive activity in the circulation, for a time, in these parts, fol- 
lowed by congestion or stagnation of blood. This causes the 
throwing out of serous effusion into the cellular tissue beneath 
the mucous membrane. With this serous effusion is mingled 
some amount of plastic material. This effusion distends the 
tissues, and causes a soft, semi-fluctuating feel to the touch 



1 66 EATON ON DISEASES OF WOMEN. 

for a time. After a period, varying from two months to sev- 
eral years, this effusion organizes into non-elastic, fibrous 
tissue in some cases of induration. This may remain, and 
produce no inconvenience to the patient. In other cases it 
serves as a nucleus for the development of fibrous tumors or 
cancerous disease. In other instances non-striated muscular 
tissue is formed, causing hypertrophy without induration. In 
still other cases continuous irritation keeps up continuous 
effusion, and there is a puffy, though hypertrophied, condition. 
Disorders of menstruation are frequently connected with 
hypertrophy and induration. 

Differential Diagnosis. 

The diseases with which hypertrophy and induration of 
the cervix are most likely to be confounded are acute inflam- 
mation of the uterus, a fibrous uterine polypus, which has 
been expelled into the vagina, having so short a pedicle as to 
be almost stationary and as large as a hen's egg, cauliflower 
excrescence of the cervix, cancer of this part, and the condi- 
tion of pregnancy. 

From acute inflammation it is to be diagnosed by absence 
of heat, tenderness and fever, and from the history of the 
case, showing the difficulty to be chronic ; from the fibrous 
uterine polypus, by discovering the os uteri at the depending 
position of the enlargement which could not be found in the 
fibrous polypus ; and by passing the finger by the side of the 
polypus we would feel its neck entering, or attached to, the 
side of the os uteri. In cauliflower excrescence, the feel is 
extremely uneven, the unevenness being like folds, with the 
creases between them branching irregularly, some of the folds 
being ear-shaped, and bleeding profusely on slight touch. 
From pregnancy, by the history of the case, and the accom- 
panying symptoms peculiar to that state (though absence of 
menstruation coming on gradually might complicate a case of 
induration or hypertrophy); it is more usual, however, that 



INDURATION AND HYPERTROPHY. 167 

the flow is very profuse. Exceptional cases do occur where 
it is scanty, and in some it is entirely absent. 

Again, we must take into account the length of time these 
symptoms have been present. If suppression has existed for 
several months, the uterus could be felt in the abdomen, if the 
case was one of pregnancy. If it could not be felt there, and 
the os was open, we would be justified in ruling pregnancy 
out of the question. Besides, when suppression does come 
on, in these cases of induration, it is gradual, and not sudden, 
as is usual in pregnancy. 

In cancer of the cervix we have the induration and 
enlargement, and also the sharp lancinating pains, mostly or 
entirely felt at night, and the cancerous cachexia is present, 
the two latter symptoms not being present in ordinary hyper- 
trophy or induration. In cancerous ulceration of the cervix 
the odor of the discharge is distinctive, but can not be 
described. The physician of experience will, however, read- 
ily recognize it. It is to be hoped that every student will 
have the privilege of seeing a case in hospital before en- 
gaging in private practice. He will then readily recognize 
the odor. 

Treatment. 

The remedies from which we receive the most benefit 
are Ars. iodid., Phytolac. dec, Nux, Secede, or Merc. cor. 

I can not advise reliance upon internal medication alone 
in this disease, though it is of much value in putting the 
general glandular system in a healthy condition, and pro- 
moting secretion and excretion, digestion, and assimilation, 
which is of much importance. By conjoining local treatment, 
much may be accomplished. I am well aware that some 
homoeopathists claim that local treatment in all diseases is 
quite unnecessary, and often injurious. (To the latter asser- 
tion I subscribe when it is improperly used, or is of too 
severe a character, but to the former I can not agree.) 

Quite a prominent author, who maintains that local treat- 



108 EATON ON DISEASES OE WOMEN. 

merit of the uterus is a snare and delusion, was asked, in a 
medical convention, in my hearing, if he had ever treated 
a case of endo-metritis. His reply was, No. Now, I can 
but suppose that, this being the case, he either had had 
little experience in diseases of women or had not been very 
thorough in diagnosis. Still this gentleman condemns strongly 
those who use local treatment. I must conclude that he 
does so from theoretical reasons, and not from his own prac- 
tice and experience. However this may be, I am disposed 
to write my own opinion, founded upon my own experience 
and that of others. 

I will say that, in my hands, the local application of 
Tr. of Iodine or a Solution of Iodine, in various degrees of 
strength (five to fifteen grains to the ounce), has accomplished 
much good in softening the indurated cervix, and in causing 
diminution of size in cases of hypertrophy. I apply the 
remedy, with a soft brush, to the exterior of the cervix, 
taking care not to have too much liquid upon the brush, so 
that it might flow off or to the mucous membrane of the 
vagina. I apply the same remedy to the interior of the 
cervix with a director something like a uterine sound, only 
not enlarged at the extremity, and wrapped around with 
raw cotton, dipping this into the fluid, and passing it into 
the cervix, where it should remain for a minute or two. 
After making these applications through the speculum, which 
should be repeated only once in three or four days, I gen- 
erally introduce a wad of cotton (to which is attached a 
twine string), firmly against the os. This serves to protect 
the vagina, and retains any superabundant iodine in contact 
with the cervix. I direct the patient to remove the cotton, 
in about twelve hours, by means of the string. The patient 
should lie in a recumbent posture for a half hour or so after 
the treatment. 

This plan, in connection with internal remedies, will soften 
the induration and very often greatly reduce the size of the cer- 



INDURATION AND HYPERTROPHY. 



169 



vix. Much depends upon the length of time the hypertrophy 
or induration has existed as to the length of time required for 
relief. I would not promise the patient relief in any speci- 
fied time, as a period named shorter than the results finally 
justify will discourage the patient, while a time long remote 
would discourage her in the outset. 

I must acknowledge that some cases are not amenable to 
medical treatment. They are usually those of many years' 
standing, or of congenital origin. In these intractable cases 
we may be justified in resorting to surgical treatment- This 
consists in amputating the superfluous tissue. It may be 
performed with the scissors, or the ecraseur, with but little 
trouble and with little fear of hemorrhage. Styptics should, 
of course, always be at hand to arrest any free flow of 
blood that might occur. The important thing after the op- 
eration is to maintain the size of the os uteri, and prevent 
its closing. Taking four stitches in the manner shown in 
Figs. 16, 17, is an efficient means to accomplish this object. 




Fig. No. 16.— Stitches inserted after 
Amputation. 




Fig. No. 17.— Sutures tightened 
after Amputation of cervix 
Uteri. 



These sutures should be of silver wire, arid should be 
inserted as shown, so as to draw the mucous membrane of 
the vagina over the stump, and also serve to draw out to 
some extent the mucous membrane of the cervical canal, and 



170 EATON ON DISEASES OF WOMEN 

prevent a cicatrix, which might close the os. This plan, 
also, has the advantage of causing healing by first intention 
of a large part, if not all, of the stump, which saves much 
time from that required for healing by granulation. The 
sutures may be cut and removed about the seventh day. A 
wad of cotton smeared with vaseline applied twice a day 
against the os is a desirable dressing, both before and after 
the sutures are removed. It is best to do this without the 
aid of the speculum, as its introduction will, in a measure, 
bruise the stump, and prevent healing. The sutures may 
best be inserted and removed with the aid of Sims' speculum 
improved by Dawson. (See Plate III in chapter on In- 
struments.) 

Amputation of the cervix uteri with the ecraseur does not 
positively demand the use of any speculum. The patient ly- 
ing upon the side or back with the thighs drawn up is given 
an anaesthetic. We then pass the loop of the ecraseur chain 
into the vagina, directed by two fingers of the left hand ; ad- 
just it around the cervix, being careful not to press it up 
so high as to amputate above the vaginal juncture ; have an 
assistant tighten the chain and screw it down as we direct, 
till it is firm upon the cervix, when we may remove our 
fingers from the vagina, and complete the operation. 

We next insert the speculum, seize the stump with a 
strong tenaculum, draw it down and insert the sutures as rap- 
idly as possible, withdraw the speculum, release the stump, 
insert a wad of cotton smeared with vaseline, and the opera- 
tion is completed. 

Amputation of Cervix Uteri with Scissors. — Let the 
patient be given an anaesthetic, and then placed upon the 
operating table on her back or side, with the thighs well 
drawn up. We now draw down the cervix with the vulsel- 
lum forceps exterior to the body. Have an assistant hook a 
strong tenaculum into the cervix above where we intend to 
amputate to prevent the stump from retracting, then with 



INDURATION AND HYPERTROPHY. 



171 



strong scissors sever the tissues. We now apply Ferri Per- 
Sulph. to the stump and stitch the vaginal membrane over it, 
as previously directed, after amputating with the ecraseur. 

To remove the sutures the same plan may be adopted, 
or we may insert the scissors into the vagina with the right 
hand, directed by two fingers of the left in the vagina, when 
we may cut them seriatim, and insert a pair of needles 
or polypus forceps, and extract one at a time till all are 
removed ; or we may remove them with Cutler's suture 
forceps and cutter. 

Various Other Methods of Treatment. — Professor Emmet 
urges a liability to return, as an argument against amputation, 
and adopts the plan of taking out a wedge-shaped piece of 
tissue, the apex of which is upwards, and the base to include 
most of each lip of the cervix. His operation is much more 
difficult, and offers more danger of closure of the os, and I 
can not see that it presents any advantages over amputation. 

The use of injections of diluted Solu. Iodine into the 
substance of the tissues of the cervix has been recommended 
as efficacious in promoting absorption and softening of the 
induration — for this purpose a syringe, similar to the ordi- 
nary hypodermic, is used, larger in size, with tubes about 
three inches long. (See Fig. 18.) 




Fig. No. 18. — Syringe for Injecting Fibroids. 

In my experience this treatment is only applicable to 
cases which are extremely free from sensibility, as otherwise 
it produces great pain. In cases which have withstood the 



172 EATON ON DISEASES OF WOMEN. 

use of remedies and local treatment, the injections may be 

made at intervals of three days (not using them, however, 

very near to the menstrual period), making about three 

punctures and injections at each treatment, throwing in 

about twenty drops into each puncture, using the following 

prescriptions : 

Ify. — Iodine Ees., grs. x. 

Kali Iod., grs. xxx. 
Kali Brom., grs. xxx. 
Aqua, I i, Hi,. 

Dr. John M. Bennett,* of Liverpool, England, I believe 
■was the first to recommend and use this treatment, which 
he highly commends. He advises its use also in cases of 
chronic cervicitis, which would indicate that he would not 
restrict its use as much as has been, in my experience, advis- 
able. The combination of the Kali iod. renders the Iodine 
soluble in water, and dispenses with alcohol, and the bromide 
tends to prevent as much pain as would otherwise result. 
After this treatment the patient should lie perfectly quiet for 
three or four hours, and if possible longer. 

Vaginismus — Dyspareunia. 

Vaginismus, as a distinct disease or difficulty, was first rec- 
ognized by Dr. Sims in 1857. Dr. Robert Barnes, of London, 
has seen fit to coin a new name for this condition, which is 
dyspareunia. This term of Dr. Barnes truly enough signifies 
painful union in copulation, but is objectionable in that painful 
copulation may be due to inflammation and tenderness of the 
uterus as well as the vagina, and may exist independently of 
any vaginal irritation or spasm ; I therefore prefer to adhere 
to the term vaginismus, generally understood to mean a 
super-sensitive condition of the whole or a part of the vagina, 
accompanied with spasmodic closure from very slight contact, 
even with the finger, rendering copulation either extremely 

* Dublin Jour. Med. Science. 



VA GINISMUS—D YSPA R E UN I A. 173 

painful or impossible, causing much distress to body and 
mind, and sometimes sadly disturbing the peace of families — 
standing as a barrier against the completion of conjugal 
duties, including the rearing of offspring, and making life a 
burden instead of a blessing. 

Though not immediately dangerous to life, this condition 
tends greatly to shorten it by the depression of spirits, and 
consequent derangement of the digestive and assimilative 
functions. 

It is most common in women recently married, and, I 
may add, those who have married at an advanced age, being 
very unusual among those who have once become mothers. 
Hence the difficulty is one of very great embarrassment as 
well as pain and annoyance. The patient sometimes imag- 
ines (when recently married) that this state of affairs is 
common to all women, and she tries to endure it. The con- 
jugal relation is irksome and loathsome to her, and she 
becomes fretful, sullen, and despondent. She communicates 
to no one the cause of her depression and sorrow, and her 
husband is suspicioned by her friends of being unkind to 
her. The husband often is unaware of the severity of the 
suffering endured by the wife, and is annoyed, if not dis- 
gusted, with her fretfulness and depression, as well as want 
of pleasure in his company, and accuses her of cold-hearted 
indifference. So on it goes, from bad to worse, till a sepa- 
ration and disgrace follow, as a more desirable state than 
this just described. 

All this trouble and sorrow might be aA^oided if the 
physician would suggest to young men about to marry that 
they might have some trouble of this kind, and bid them to 
be cheerful, under the assurance that it could be remedied, 
and was excellent evidence of the chastity and purity of 
the wife, and bidding them be very gentle and moderate, 
seeking medical aid if things did not soon right themselves. 

Dyspareunia, or painful connection, may be also due to 



174 EATON ON DISEASES OF WOMEN. 

inflammation of the uterus, or ovaries, or displacements of 
these organs, inflammation of the vagina, disproportionate 
size of the male organ, want of sexual passion, cystitis, etc. 

Symptoms. 

Usually the physician will be consulted by the husband of 
the patient, who will state that the attempt at copulation pro- 
duces in his wife extreme pain, or that it is impossible to 
perform the act at all, owing, as he thinks, to some malfor- 
mation of the wife's genitalia. 

If we see the patient at once, and attempt to make an 
examination of the parts, we find a cringing on the part 
of the patient as soon as the finger is inserted between the 
labia, in some instances; and, upon attempting to pass the 
finger into the vagina, we feel it to be spasmodically closed. 
If, by using some force, we succeed in inserting the finger, 
it is grasped by the sphincter vaginae, and held very firmly. 
We will note, usually, an absence of normal moisture, and 
the finger should be smeared with some oleaginous substance 
before making an attempt at an examination. 

Upon placing the patient under the influence of an 
anaesthetic, this rigidity is found to relax, and w T e can pro- 
ceed to examine the position and condition of the uterus. 
The sound will determine any flexion which may exist, and 
there is no call for the introduction of a speculum in these 
cases. In attempting to make a digital examination we may 
sometimes find it impossible, even with the aid of the anaes- 
thetic, and we feel the hymen, as a firm, smooth obstruction, 
quite the contrary from the drawn together feel of the spas- 
modic contraction. This is, of course, a case of thickening 
of the hymen, or an imperforate hymen (in case we can find 
no opening at all), and does not come under the head of 
vaginismus. 



VAGINISMUS— DYSPAREUNIA. 175 



Etiology. 



The cause of vaginismus is sometimes in the general 
supersensitive condition of the nervous system, called gen- 
eral "hyperesthesia," and may result from a local hyperes- 
thesia of these parts. This local hyperesthesia may be clue 
to the inflammation of the vagina, vulva, meatus urinarius, 
or urethra, fissures, or hemorrhoids, moderate cellulitis, 
flexions or versions of the uterus, irritating discharges from 
the uterus, great size of the male organ, brutality and vio- 
lence of the husband in the attempt at sexual congress, 
etc., etc. 

These causes may also develop at a period somewhat re- 
mote from the marriage day, owing to excessive coitus, causing 
vaginitis, or owing to the development of some of the enu- 
merated causes, at any time. 

Some authors name hysteria as a cause of vaginismus; 
but, to my mind, in this theory the effect is mistaken for 
the cause. 

Educated women are much more frequent sufferers from 
vaginismus than the uneducated. This is doubtless due to the 
greater exhaustion of the nervous system, and consequent im- 
pairment of glandular and muscular strength. With most of 
these women the animal nature is stunted from want of phys- 
ical exercise, and exhausted by keeping late hours, and from 
hard study, and loss of sleep. 

The mental determination to suppress every sexual emo- 
tion causes, in time, a loss of virility, not complete, it is true, 
in many instances, but very generally a serious impairment. 
In these cases contemplation of the sexual act is repulsive ; 
there is an absence of secretion naturally thrown out by the 
sebaceous follicles, in the labia and njmiphe, while in the em- 
brace of her husband, and, consequently, there is dryness of 
the parts, instead of moisture. This absence of moisture, 
with the little or no sexual passion felt, are important agents 



176 EATON ON DISEASES OF WOMEN. 

in causing pain and spasmodic closure of the vagina when 
sexual congress is attempted, — all having the foundation cause 
in the atony and atrophy of the female genitalia, induced by 
the exhaustion of the entire system from mental labor. 

Neftel,* of France, was the first to suggest that moderate 
lead poisoning, from using cosmetics containing lead, may oc- 
casionally produce vaginismus ; and I am quite sure he is 
right. I have, in several instances, observed this condition 
apparently produced by cosmetics containing lead. In other 
cases it produces paraplegia or neuralgia. 

Treatment. 

The first thing in the treatment is to ascertain what there 
is in the particular case in hand which causes the trouble. 
Perhaps the best prescription which can be made for cases 
ordinarily, if we must prescribe before making a physical ex- 
amination, is to give, according to the homoeopathic indica- 
tions, either Ignatia, Nux, Aconite, Bell., or Ars., internally, with 
Belladonna Ointment, diluted one-half, passed in small quantity 
between the labia minora and up into the vagina, by the 
patient herself, twice a day, using very warm water vaginal 
injections, in large quantity, at least once a day, taking warm 
sitz baths at night, before retiring, etc. Should this treatment 
fail of giving relief in a week or two, we should insist upon a 
physical examination. 

For this purpose we may have our assistant, or the hus- 
band, administer some Ether compound, or Ether alone. We 
should then proceed to ascertain at once if there is any dis- 
placement of the uterus, and if so, proceed to replace it. 
If the uterus is inflamed, this condition will be indicated by 
heat and swelling, and we can adopt suitable treatment for 
this condition subsequently. 

We should also, at this time, examine for fissures of the 
anus or vagina, and for hemorrhoids, and also as to the condi- 

* L' Union Medicate, 1869, No. 19. 



VAGINISMUS— DYSPAREUNIA..:. 177 

tion of the urethra and its meatus extern us. If any thing 
abnormal can be discovered in these parts, of course, the 
indication is clear to treat these conditions till cured, when, 
it is most probable, the vaginismus will be relieved as well. 
(Copulation while the patient is under the influence of an an- 
aesthetic has been practiced, in this country, to induce concep- 
tion, that parturition might cure the difficulty.) Dr. Pack- 
ard* reports a case where conception occurred, although the 
penis never entered the vagina. It is to be expected that 
the delivery of a child will effectually cure the vaginismus; 
hence, it is always desirable,- in these cases, that conception 
should take place. 

Some gynaecologists incise the vagina in several places, 
cutting deep enough to sever some of the fibers of the con- 
strictor muscle, and then insert a dilator, well oiled, retaining 
it till the incisions are healed. This operation has most fre- 
quently been performed by Dr. Sims, Avho has also invented 
the plan of gradual dilatation with glass or hard rubber cyl- 
indrical dilators of various sizes (see Plate VI), commencing 
with the smaller, and gradually using larger and larger ones 
from day to day. This latter plan is very generally approved, 
and has been an efficient means in my hands when conjoined 
with the use of diluted belladonna ointment or vaseline, to 
smear the dilators before they were introduced. 

As a rule, however, we have no need to use even as 
severe means as the vaginal dilators. Warm vaginal injec- 
tions and the occasional application of Bell. Ointment and 
Vaseline, equal parts, with the finger, either by the physician 
or patient herself, conjoined with indicated remedies for 
this and other symptoms in the case, together with atten- 
tion to diet, hygiene, food, mental quiet, and a cessation 
of attempts at copulation, are usually successful. When this 
plan of treatment fails it is time enough to use the dilators 
or make incisions. 

* Amer. Jour. Obs., Vol. II, p. 348. 
12 



178 EATON ON DISEASES OF WOMEN. 

It will be judged by the thoughtful student that efforts 
at connection would prove injurious and tend to prevent 
recovery. This is the case, and it is better to forbid every 
eifort at sexual congress till the patient is thought to be 
recovered. 

Indications for Remedies. 

Arnica is indicated where the vaginismus has resulted 
after copulation, or injury of any kind. 

Aconite is indicated where there is present vaginismus, 
with heat and tenderness in the vagina, with a wiry pulse, 
aching in the limbs, fever, etc. 

Bell., where there is drowsiness, with bearing down 
pain; pain in the small of the back, a flushed face, etc. 

Ignatia, in the case characterized by weakness, nervous- 
ness, insomnolence, etc. 

Hyosc. is indicated if there is a tendency to hysteria, 
frequent weeping, immodesty, etc. 



ULCERATION OF THE OS UTERI. 179 



CHAPTER XV. 

ULCERATION OF THE OS UTERI. 

I write a chapter on ulceration of the os uteri, not that I 
expect any student will soon see a case, unless it be one of a 
specific character, but to express the opinion that true ulcera- 
tion is very rare in this locality. From the frequency with 
which we hear physicians speak of ulcerations of the womb 
one would suppose the disease was one that the gynaecologist 
would see daily; but this is not the case; on the contrary, 
they are seldom seen even as small pimples, tending to 
ulcerate. If we use the term ulcer, as it is applied to other 
tissues, parts, or organs of the body, I may say we seldom see 
it, except in syphilis or the phagedenic or cancerous ulcera- 
tions, which are not intended when we speak of ulceration in 
general terms, and are always designated specifically as such, 
when present. 

The ulceration spoken of by physicians so often (see chap- 
ter on Cervicitis), is simply a, sub-acute inflammation of the 
vaginal mucous membrane, covering the cervix uteri, the 
epithelial layer being absent (which will usually be the case 
after one application of caustic, and this is the almost uni- 
versal treatment used by the allopathists, whether they see 
fit to diagnose the case ulceration, inflammation, induration, 
hypertrophy, chronic endo-metritis, or endo-cervicitis). Muco- 
purulent matter is sometimes thrown off from this inflamed 
surface of the cervix uteri, but it is not ulcerated as the 
term is generally understood. In these cases there is no 
depressed center, there is no disposition to slough; on the 
contrary, this inflamed surface is usually more elevated than 



180 EATON ON DISEASES OF WOMEN. 

the adjacent mucous membrane. The term ulceration ap- 
plied to this condition I consider a misnomer. 

When the inflammation is of a rather high grade to be 
termed chronic sub-acute, almost coming up to an acute 
inflammation, we sometimes have small pimples which are 
exceedingly red, with a base considerably inflamed. These 
pimples seldom attain to a size larger than that of two or 
three pin heads, and usually pass away without ulcerating. 
Occasionally they have a little matter in them, which is dis- 
charged ; but even then the disorder is so slight, as regards 
the ulceration, as to be unworthy the name. I have never 
seen them fail to heal, in a short time, under the mildest 
treatment. Under a severe caustic treatment the healing 
process might be indefinitely postponed if it was used with 
any degree of frequency. 

The irritable ulcer mentioned by Professor Ludlam, that 
shows no disposition to heal, but rather increases in depth 
and size, I think will be found on investigation to be specific 
in its character, or the result of direct violence, as incisions, 
wearing a hard pessary for a long time, or a laceration in con- 
finement in broken down scrofulous subjects, and will seldom be 
met with. Still, as we will sometimes see them, we may 
well pay some attention to their consideration. 

The class resulting from laceration of the os in confine- 
ment is more numerous than is generally imagined, from the 
fact that they many times exist without being discovered, 
owing to careless examination or a failure to comprehend 
their nature and appearance. 

The ulcers resulting from unhealed lacerations of the os 
are in appearance deep fissures, and generally double, i. e. 
one situated upon either side of the neck, the outer margins 
of which we find covered with mucous membrane, and some- 
what increased in color from the natural tint; but on separ- 
ating these false lips as it were, we discover pus in the 
bottom of the fissure, and, on wiping it away, we see the raw, 



ULCERATION OF THE OS UTERI. 181 

ulcerated condition of the bottom of the fissure, which, by 
the way, is, of course, upwards towards the fundus of the 
organ. These fissures or ulcers may exist singly, either 
from the fact of one of them having healed, or from the lac- 
eration having occurred only at one point. 

The pathological condition recognized by some authors as 
ulceration is really one of sub-acute inflammation. Notice the 
description given by Prof. Byford.* He says : 

"After the inflammation has lasted for a time, if its in- 
tensity is increasing, the epithelium gives way, more or less 
completely. This epithelial denudation is the simplest and 
most common form of ulceration met with in practice. Of 
course, in this form of ulceration the red portion is not de- 
pressed; it retains its level with the adjoining surface, and, 
consequently, the term ulceration is not considered applicable 
by some writers. After the epithelium is lost for some time, 
there is a gradual increase in the size of the papillary structure 
of the membrane, covering the neck of the uterus, and if 
the membrane is now examined, instead of the smooth red- 
ness there is something of a velvety or plushy appearance. 
The intensely red surface is covered by, or, rather, seems to 
be formed of, an infinite number of extremely minute pro- 
jections so closely opposed that there is hardly any space 
between them. The papillary projections do not seem larger 
than the minute silk fibers of velvet, as short and as thickly 
set. This surface is almost always covered with mucus and 
pus in different proportions of admixture. There is always 
pus, however, when this complete absence of the epithelium is 
observed. Still the evenness of the mucous surface is not dis- 
turbed. There is no excavation at least. If there is any 
change in this respect, the red patch is slightly elevated 
above the surrounding surface. This kind of surface is al- 
ways seen upon a greatly enlarged cervix, which is also 
very much indurated. It is very obstinate, but will usually 

*" Medical and Surgical Treatment of Women," pp. 185-7. 



182 EATON ON DISEASES OF WOMEN. 

yield to sufficiently energetic and long continued treatment. 
The boldness of the use of caustics necessary to the cure of such 
cases as these requires strong nerves to institute and thorough!?/ 
execute." (The italics are my own.) 

It will be noticed that Dr. Byford states that "this is 
the simplest and most common form of ulceration met with in 
practice." And, regarding treatment, says: "The boldness 
of the use of caustics necessary to the cure of such cases re- 
quires, strong nerves to institute and execute" but says, " the dis- 
ease is very obstinate." Is it any wonder? 

The application of caustics to the healthy os uteri will 
cause the exfoliation of the epithelial layer of mucous mem- 
brane, as described, with all the accompanying symptoms 
mentioned, which really are but the efforts of nature to re- 
store the loss of tissue produced by the inflammation either 
with or without the caustics. It is one of the mysteries of 
medicine that intelligent gentlemen should have applied 
caustic applications heroically, perseveringly, and eternally, 
where the success was so problematical, as they acknowl- 
edge, and where reason and philosophy seem to be ignored. 
Especially is it strange among those who claim to be so par- 
ticularly scientific, as do the old school. It is on a par with 
the universal use of blood-letting practiced by this school of 
medicine thirty or forty years since, which has fallen entirely 
into disuse; and it is to be hoped that very soon caustic 
applications to the os uteri may be as seldom used as is 
blood-letting at the present day. 

In these remarks I intend no disrespect to Prof. Byford ; 
on the contrary, I selected a quotation from him because I 
thought he gave one of the best descriptions of the appearance 
of the os in these cases to be found in any work, and as I know 
the treatment recommended by him is a true statement of 
the actual practice of his school to-day. I cheerfully acknowl- 
edge the obligation I am under to him for instruction twenty 
years since, and I hope I shall always remember the respect 



ULCERATION OF THE OS UTERI. 183 

I owe to him and other old school physicians who did so 
much for me in my student days, and also in the first years 
of my practice. If I now differ with them, it is only 
reluctantly, after having found by experience that we have 
in homoeopathy a law for the selection of remedies in the 
treatment of disease, and that the treatment of disease with 
remedies selected by this law is much more satisfactory than 
by the old school methods. 

This description of ulceration by Prof. Byford is proba- 
bly as good a statement of the condition of the os in cases 
so frequently called ulceration as can be found or written. 
Still, I see no good reason to apply the term ulceration, as 
it certainly deceives patients and friends in regard to the 
true nature of the difficulty, and gives great distress to some 
sensitive ladies, amounting to almost an abhorrence of life 
and detestation of themselves. Generally some leucorrhoea 
is present in these cases, and the patient imagines that the 
interior of her vagina must be perfectly horrid, if it is so 
ulcerated as to cause such a discharge. It is natural that 
she should feel much discouraged and depressed in mind — 
the very condition we wish to avoid, if possible. But, on 
the contrary, with the explanation of the physician that the 
difficulty is chronic inflammation of the neck of the womb, 
and that it looks somewhat red and swollen, and we explain 
that the discharge is the result of this inflammation, it causes 
much less alarm, and hopefulness takes the place of fear and 
despondency. 

There is very generally a tendency to despondency in 
all forms of uterine ailments, and to avoid this should be a 
constant aim of the physician. 

Diagnosis. 

Here we need the aid of the speculum — in fact, without 
it no diagnosis could so well be made. The digital exam- 
ination would not reveal any considerable heat or tenderness 



184 EATON ON DISEASES OF WOMEN. 

ordinarily, unless hard pressure was made (which would 
produce some pain in case of the fissured ulceration of lacer- 
ation before mentioned, where the lacerations had not healed), 
or in case the ulceration had resulted from scarifications or 
single incision, where we would have the smaller fissure. 
The chancre does not differ, when seated in this locality, 
from its appearance when situated on other mucous surfaces. 
For differential diagnosis regarding cancerous ulceration, see 
"Cancer of the Uterus." 

Occasionally we may find a true ulcer of the os, exca- 
vated, discharging pus, the margin blanched or white, the 
center red, and showing small granulations after we wipe 
away the pus. I Avill suggest that we have always at hand a 
dossil of lint or cotton or soft sponge, and a pair of long 
dressing forceps, with which to wipe away any secretions 
which may cover the os ; otherwise we may be sadly misled 
in diagnosis. 




Fig. No. 19. — Uterine Dressing Forcers. 



The red spot may be only a few drops of blood which has 
just passed out of the os, surrounded with some mucus ad- 
hering to the neck of the womb, simulating an ulcer some- 
what. Still we may not be misled if we recollect that, in the 
case of the true ulcer, we would have pus covering this red 
center, unless we had previously wiped it away; and again, 
in the true ulcer, we have the depressed center, with irregular 
white border, which can not be wiped away. Surrounding 
this whitish margin we may have the mucous membrane con- 
siderably inflamed and quite red. Especially is this so, if it is 
caused from the wearing of a hard pessary. 



ULCERATION OF THE OS UTERI. 185 

Treatment. 

True ulceration, I believe, will seldom be found in the 
robust patient; and, when we find it, we will have need to 
recollect that good nourishment is a desideratum. Remedies 
calculated to build up the system by exciting healthy gland- 
ular action, healthy secretion, assimilation, and excretion, as 
well as general nerve strength, are needed. They may be 
found among the following remedies, selected according to the 
peculiar symptoms of each case : Merc, pro., Ars., Phytolac. 
dec., Nux, Col. carb., Sepia, Lachesis, Ly cop odium, Iodium, 
Thuja, etc. As a local application I would use Solution Iodine, 
twenty grs. to the ounce, applied with a camel's-hair pencil 
daily, applying it only to the center of the ulcer, or, in 
case of the fissure, to the bottom of it, first removing the 
pus with a bit of cotton. This will cause granulations to fill 
up the depressed surface, and, when that is accomplished, the 
mucous membrane will form over the ulcer. God only knows 
how. He, acting through established law, has made provision 
for the restoration of solutions of continuity of tissue. How 
this process is accomplished, either in bone or flesh, we are as 
ignorant as the new-born babe. Still, to place the system in 
a favorable condition, and sometimes aid nature, seems to be 
our privilege, though we know not the process of cure more 
than we can understand the selective affinity in the animal 
or vegetable world, which selects and appropriates food for 
the various parts of the animal or plant, from elements, to our 
dull sense, apparently as diverse as possible. But so it is, 
and probably so it must remain. 



186 EATON ON DISEASES OF WOMEN. 



CHAPTER XVI. 

vaginitis— adhesions in the vagina from inflammation- 
diphtheritic inflammation of the vagina — peri- 
vaginitis phlegmonosa dissecans. 

Vaginitis. 

This term indicates an inflammation of the lining mem- 
brane of the vagina. It is more frequently chronic than 
acute. An acute attack, resulting from cold, is denominated 

CATARRH OF THE VAGINA. 

It may attack girls or women of any age. In acute 
attacks the symptoms most complained of are, heat, burning, 
and itching of the part. The inflammation generally affects 
the mucous membrane of the labia at the same time, and, 
consequently, it sometimes becomes very painful in walking, 
as the moving of the limbs chafes the labia, already inflamed, 
and causes great pain. In two or three days after an acute 
attack of vaginitis, which is often ushered in by chilliness of 
the whole body, there is pain in the limbs, back, etc., gen- 
erally an increase of temperature, and a rapid, wiry pulse, 
tongue generally with a white coating, loss of appetite, with 
sometimes nausea and vomiting. 

Very often these symptoms last mentioned are the only 
ones complained of to the physician, and he is liable to 
make a diagnosis of int. fever, or bilious fever, or congestion 
of the stomach, or stomatitis. After the lapse of a few days, 
however, there is a copious flow of mucus and muco-puru- 
lent matter from the vagina, which is more likely to cause 
the patient to make known to the physician the true state 
of affairs. By this time the patient will generally feel 
inclined to take to her bed, if she has not clone so already. 



VAGINITIS. 187 

I have here described the more violent form of acute 
attacks of vaginitis. The large majority of cases are more 
mild in their symptoms. These severe acute attacks are 
usually due to cold taken at the menstrual period, when 
we are likely to have also some metritis complicating the 
vaginitis. Tedious labor, where the head is impacted in 
the vagina, is a cause of severe vaginitis occasionally, and 
is to be avoided if possible, even if it is necessary to use 
instrumental delivery. It is much safer in skillful hands 
than the long impaction of the head. 

Traumatic lesions from the use of instruments in labor, 
craniotomy, or removal of uterine polypi, or uterine fibroids, 
or other violence, the use of strong vaginal injections, ex- 
cessive copulation (or violence of the act, especially in those 
just married) may produce acute inflammation of the vagina 
and labia. 

The specific inflammation of the gonorrhoea! poison will 
be discussed under its proper head. The differential diag- 
nosis is sometimes difficult. The character of the patient 
and the history of the case will aid us some in distinguish- 
ing the specific from the non-specific. Objectively and 
subjectively, the symptoms are much alike. Where the 
patient is of good character we usually will, of course, have 
the non-specific inflammation, while in the case of prostitutes 
we may have non-specific inflammation from causes mentioned ; 
still, they are comparatively rare among these women. 

In gonorrhoeal inflammation, generally, painful micturition 
is one of the first symptoms, while in the non-specific it 
comes on later in the case, if at all. The smarting, even 
then, is mostly confined to the interior of the labia, and not 
to the tract of the urethra, as in specific inflammation. Bubo, 
which often results in the female (though not as often as in 
the male) from gonorrhoeal vaginitis, seldom, if ever, accom- 
panies non-specific inflammation of the vagina. 

This acute inflammation generally causes so much ten- 



188 EATON ON DISEASES OF WOMEN. 

derness that even a digital examination is extremely painful; 
and I would specially warn all young physicians to not 
attempt to introduce a speculum in such cases. The swell- 
ing and tumefaction of the parts, as well as the tenderness 
and vaginismus, lessen the size of the vagina, and make the 
attempt to introduce the speculum a cruelty. 

We may have in these cases of acute vaginitis various 
sympathetic symptoms very much resembling those produced 
from uterine disease — pain in the back and limbs, constipa- 
tion of the bowels, weakness, etc., etc. This acute inflam- 
mation sometimes produces abscess in the labia majora, which 
is particularly embarrassing with newly-married ladies, and 
it is just this class which is most frequently affected with 
abscess of the Libia. In these cases it Avill sometimes be 
found that the inflammation first attacked the labia, and 
spread to the vagina. 

Ascarides sometimes produce this disease in young girls, 
and sometimes from want of cleanliness of the parts, in con- 
junction with a sudden cold, vaginitis may be developed. 

Chronic Vaginitis is more common than the acute. It 
exists in a sub-acute form in many women for years, produc- 
ing leucorrhcea, sometimes painful vaginismus, which makes 
the act of copulation very painful, if not entirely impossible. 
In other cases there is little tenderness or heat, but, on the 
contrary, a relaxed cool state of the parts; still, upon exam- 
ination, the vaginal mucous membrane looks red, and we ob- 
serve an inordinate amount of mucus, and sometimes muco- 
purulent matter. This discharge is usually so profuse as to 
be exceedingly annoying to the patient. Generally there is 
little urethral irritation in this chronic form of vaginitis, nor is 
there as much disturbance of the general system as in the 
acute form. 

The causes which tend to produce this chronic sub-acute 
vaginitis are colds, resulting in a sort of catarrh, which does 
not get entirely well until another is taken, and so on. Fre- 



VAGINITIS. 189 

quenfc child-bearing, as well as miscarriages, tend to leave the 
parts either irritated or weakened, and consequently more 
sensitive to cold. Excessive venery, want of cleanliness, the 
wearing of pessaries for a long time — and, for that matter, a 
short time — will produce vaginitis in some women. The inter- 
course with husbands who have, at some previous period, 
been afflicted with syphilis is said, by some authors, to pro- 
duce a mild vaginitis; but, in my opinion, based on expe- 
rience, the most frequent cause of chronic vaginitis is dis- 
placement of the uterus — displacements of either variety do 
tend directly and materially to produce this difficulty. The 
use of washes to prevent conception is another fruitful cause 
of this disease, as well as the use of strong injections and 
the application of caustics to the os uteri. 

The excoriating nature of some of the discharges from 
the uterus passing over the vaginal membrane tend to inflame 
it, and are the cause of the obstinacy of the vaginitis, in 
some cases, in spite of all treatment, because the exciting 
cause remains undiscovered and unrelieved. 

The scrofulous habit may predispose largely to the devel- 
opment of the disease, as well as the debility of excessive 
fatigue. The presence of tumors in the pelvis of any kind 
will, of course, largely tend to produce and keep up inflam- 
mation of the vagina. 

Treatment. 

The acute attack of vaginitis will require Aconite first, last, 
and all the time, taken in the second or third attenuation, 
every three hours ordinarily. Some cases, showing depres- 
sion of strength, hot flashes, with chillings, require Ars. alb. 
o x , or higher, if you please. Perfect rest should be enjoined. 
Evacuate the bowels with enemre of soap and water, place the 
patient in a warm sitz bath for twenty minutes three times a 
day, apply warmth to the feet, inject into the vagina, and 
also apply a soft cloth between the labia wet with a wash 
made of Tr. Aconite z i. Aqua, 0. ss. Still maintain rest and 



190 EATON ON DISEASES OF WOMEN. 

give a non-stimulating diet — cold water may be drank of 
moderate temperature, omitting tea and coffee. After a day 
or two following this treatment, I usually apply to the vaginal 
surface an ointment of Bell, diluted with simple cerate, about 
four hundred per cent, applying it with the finger thor- 
oughly, which relieves the tenderness rapidly. Another 
excellent application is a wash (used with the syringe) 
of Hydrate of Chloral 15 grs. to aqua % i, injected every 
four hours. 

As soon as the tenderness disappears sufficiently to admit 
of so doing, it is well to make a thorough physical examina- 
tion with the speculum and sound, and also see that there 
are no tumors in the vagina causing irritation. If uterine 
displacements are present, we need not expect any treat- 
ment short of placing the organ in situ, and maintaining 
it there, will be of any avail in permanently relieving the 
vaginitis. Tumors, of course, should be treated according to 
the kind and condition. The use of vaseline, introduced into 
the vagina on the finger two or three times a day, will be 
found very serviceable (the patient may be taught to do this). 
Copulation, of course, is to be interdicted. Warm drawers, 
stockings, and shoes are to be advised, with moderate exer- 
cise during convalescence. In severe cases, especially those 
caused from severe labor, it is necessary to insert into the 
vagina some solid material, to keep the sides of the vagina 
separated and prevent adhesions. These need not be intro- 
duced until the active symptoms have, in a measure, subsided. 
They may consist of a tampon of cloth, well oiled, or smeared 
with vaseline, and left in position twelve hours. If the pa- 
tient is seen often by the physician, he may omit the tampon, 
if he introduces the ointment on one or two fingers daily. 

To Prevent Adhesions of the Labia, which might occur, 
if neglected, it is well to keep them separated with an oiled 
fold of cloth, lint, or cotton. In case we have adhesions al- 
ready formed, which will sometimes occur in a short time, we 



VAGINITIS. 191 

must break up the adhesions. This can be done by separat- 
ing the labia, and using a blunt instrument to lacerate the 
attachments, if they are few ; but if numerous, or there is a 
considerable extent of adhesion, the scalpel should be used to 
divide the attachments, and the labia must be kept well sepa- 
rated with oiled lint or cotton till healed. I often find that, 
after removing the cause of the complaint, I have no disease 
left to treat. The leucorrhoea, weakness, tenderness, and all, 
have vanished. 

The remedies most serviceable in chronic vaginitis are 
Cal. carb., Sepia, Mercury, Mux, and Puis. {Puis, especially, 
if there is amenorrhoea as a complication.) An injection of 
simple Ohio. Potass, in solution, of the strength of about five 
grs. to the ounce, is excellent, combined with the vaseline ap- 
plications mentioned in convalescence from acute vaginitis. 
In chronic vaginitis we have little fear of adhesions forming. 
Sometimes Can. ind., Canthar., Oubeb., or Bell, may be given 
to relieve the urethral irritation; but they are seldom needed, 
as the cure of the vaginitis results in the cure of the urethritis 
also. Tepid soap and water vaginal injections are desirable, 
used daily, to cleanse away the discharge, and allow of the 
direct application of the other treatment. Nourishing diet, 
good air, freedom from care and worry, are great aids in the 
treatment. 

In cases of very young girls we must be sure worms are 
not the active cause. If they are, they must, of course, be 
removed. Injections into the rectum of thin starch water, 
with a few drops of Spts. Turpentine, is an efficient remedy 
for these little pin- worms, which are sometimes the cause of 
vaginitis. Open the vagina gently, and wipe away any that 
may be seen, with a soft cloth. Bathe the parts often with 
tepid water, and gently apply vaseline, cosmoline, or basilicon 
ointment, twice a day. The remedies to be given are the 
same as for the adult. 



192 EATON ON DISEASES OF WOMEN. 

Indications for Remedies in Vaginitis. 

Aconite. — Vaginitis, with dizziness; fear of death; rest- 
lessness ; rapid, wiry pulse ; hot, dry skin. 

Arsenicum. — Vaginitis, with nausea ; aching of the en- 
tire body ; chilliness, alternating with hot flashes ; profuse 
yellowish leucorrhoea. 

Arnica. — Vaginitis from traumatic lesions; excessive 
venery ; loss of appetite ; bitter taste' in the mouth ; sensa- 
tion of cold on top of the head, with nervous depression. 

Belladonna. — Vaginitis, with bearing-down pains; vag- 
ina hot and dry; face flushed, with great thirst; urine copi- 
ous, pale, and involuntary; pulse full and throbbing, great 
disposition to perspire. 

Bryonia. — Vaginitis, with dysmenorrhoea ; menses too 
profuse, complicated with pleuritis or mucous diarrhoea ; mouth 
and lips dry, with nervous depression and dry, hacking, tick- 
lino: C0U2"h. 

Cannabis Sativa. — Vaginitis, with copious milky leucor- 
rhoea; labia swollen and tender; burning in the urethra; 
painful micturition; palpitation of the heart and frightful 
dreams. 

Cal. Carb. — Vaginitis, with leucorrhoea like milk ; dark 
offensive urine; vertigo when walking; glandular enlarge- 
ments in any part of the body ; sweating of the palms of the 
hands; feet cold and damp. (Cowperthwaite.) 

Cantliaris. — Vaginitis, with dysuria ; dryness of the vag- 
ina, with nymphomania. 

Cimicifuga. — Vaginitis, with pain in the ovaries; dys- 
menorrhoea; complicated with neuralgia or rheumatism; dull, 
frontal headache. 

China. — Vaginitis, after labor; red sediment in urine; 
painful micturition.; throbbing headache; roaring in the ears. 

Cocculus. — Vaginitis, with menorrhagia; dizziness with 
nausea. 



VAGINITIS. 193 

Carb. Veg. — Vaginitis, with an aphthous condition of 
the parts; indigestion; offensive flatus; hoarseness; tend- 
ency to sleep during the day; can not sleep at night. 

Conium Maculatum. — Vaginitis, with severe itching in 
the vagina; cutting pains in uterus, ovaries, or breast, with 
increased sexual desire. 

Digitalis. — Vaginitis, with palpitation of the heart ; mem- 
branous dysmenorrhoea. 

Dulcamara. — Vaginitis, with amenorrhoea and watery 
diarrhoea; pain in small of the back. 

Ferrum. — Vaginitis, with redness of the face; rush of 
blood to the head; amenorrhoea, epistaxis, etc. 

Gelsenainum. — Vaginitis, with sharp pains in the uterus 
and dizziness; pain in the occiput; trembling and weakness. 

Graphites. — Vaginitis, with profuse leucorrhoea; itching 
of the pudenda, with morning sickness; aversion to animal 
food; nausea from the smell of food; despondency and 
weakness. 

Hamamelis. — Vaginitis, with uterine hemorrhage, bleed- 
ing hemorrhoids, etc. 

Hyoscyamus. — Vaginitis, with hysterical symptoms ; ex- 
cessive sexual desire; immodest exposure; pupils dilated; 
eyes look wild. 

Ignatia. — Vaginitis, with frequent micturition; sighing; 
sensation of weakness; restless sleep. 

Iocli vun. — Vaginitis, with induration of the uterus, and 
swelling of the ovaries; mammse small, undeveloped; scrofu- 
lous conditions, with dark hair and eyes. 

Kreosotum. — Vaginitis, with yellow leucorrhoea; violent 
itching of the labia. 

Lachesis. — Vaginitis, with hot flashes, dimness of vision ; 
vertigo, with hysterical symptoms, in old women. 

Iiycoj)odiiiiii. — Vaginitis, with dryness in the vagina; 
excessive appetite, with hiccough; weak memory, with con- 
stipation. 

13 



194 EATON ON DISEASES OE WOMEN. 

Platinum. — Vaginitis, with nymphomania ; bearing down 
pain in the abdomen ; objects appear small ; sad, irritable mood . 

Pulsatilla. — Vaginitis, with scanty menstruation, from 
taking cold; leucorrhoea thick, like cream. 

Sepia. — Vaginitis, with great tenderness ; vagina dry and 
hot; urine turbid, with reddish sediment; yellow, sallow com- 
plexion; prostration of strength. 

Sabina. — Vaginitis, with thick, offensive leucorrhoea; 
menses too profuse; strangury; dysenteric symptoms; urging 
at stool; vertigo when attempting to walk, etc. 

Sulph. — Vaginitis, with corrosive leucorrhoea; constipa- 
tion; tenderness of the abdomen; troublesome itching of 
the labia. 

Thuja. — Vaginitis, with mucous leucorrhoea; great itch- 
ing of the genitalia; useful in cases where there is a syph- 
ilitic taint. 

Verat. Viricle.— Vaginitis, with congestion of blood in 
the brain, especially affecting its base; sense of fullness in 
the back of the neck; irritable disposition; dilated pupils; 
gastralgia, etc. 

Zincum. — Vaginitis, with irresistible sexual desire; leu- 
corrhoea thick, bloody, etc.; dizziness, with weak memory; 
mouth and lips dry. 

Diphtheritic Inflammation of the Vagina. 

When we have diphtheria affecting the throat, in severe 
cases we may have also a diptheritic exudation in the vagina, 
preceded and accompanied by vaginitis; and we may also 
have this diphtheritic inflammation in the vagina without the 
throat manifestations. Ichorous discharges from the uterus 
may produce it in cases of carcinoma of the uterus, or in 
cases of ulcerating fibroids or polypi, or in cases of vesico- 
vaginal fistula, measles, small pox, typhus, and cholera; 
and we sometimes have this complication in the puerperal 
patient. 



PERIVAGINITIS PHLEGMONOSA DISSECANS. 195 

This diphtheritic inflammation may be confined to a small 
part of the mucous surface of the vagina, or may cover it 
and the labia entirely. 

Diagnosis. 

Its symptoms are those of vaginitis, with the additional 
one of the formation of diphtheritic false membrane, and we 
have the symptoms of general exhaustion more marked and 
decided. 

Treatment. 

Locally, I find the most benefit from Solu. of Iodine, one 
or two grains to the ounce, applied with a sort of vaginal 
probang, made by attaching a small sponge to a piece of 
whalebone, and swabbing out the vagina thoroughly, after 
washing it out with tepid soap and water with the small 
vaginal syringe, using this treatment every twelve hours. 
lod. of Ars., Kali chlo., Merc, pro., China, or Rhus, etc., are 
usually the indicated remedies. The removal of the cause 
should, of course, engage our earnest attention. Granulations 
are more numerous after the exfoliation of the membrane 
than in ordinary vaginitis, and very great care is necessary 
to prevent vaginal adhesions. These must be prevented by 
the introduction into the vagina of the oiled fold of cotton, 
which must be frequently renewed. 

Peri-vaginitis Phlegmonosa Dissecans. 

I have never seen a case of this disease, and I quote 
from Ziemssen :* 

" Three cases of this affection have been described ; its 
etiology is unknown; in Marconnett's f two cases there was 
suppurative inflammation of the submucous connective tissue, 
which caused the separation of the entire vagina, including 
the mucous membrane and muscular layer, and the vagina 
was expelled in consequence in the shape of a perfect tube, 

* Ziemssen, Cyclopaedia, Vol. X, p. 496. 
tMarconnett, Virchow Archiv.,b. 34, p. 1-2. 



196 EATON ON DISEASES OF WOMEN. 

together with the mucous layer of the vaginal portion of the 
cervix. Healing followed, with suppuration. 

"The case of Minkiewitsch * was of a more malignant 
character. In this instance also the vagina was expelled in 
toto; but the patient died, and, at the autopsy, the posterior 
vesical and anterior pelvic walls were found gangrenous." 
f Mihkiewitsch, Ibid.,"b. 41, p. 437. 



IMPERFORATE HYMEN. 197 



CHAPTER XVII. 

IMPERFORATE HYMEN— ATRESIA OF THE HYMEN {CONGENITAL 
AND ACQUIRED)— HJEMATOMETRA, ETC. 

The hymen in the adult female has usually an opening 
large enough to admit the point of the index finger. In 
some women it is smaller than this, and in a few much larger, 
so that copulation, and even delivery, have been accomplished 
in a few instances without its being ruptured. But occa- 
sionally it has no opening, and is then termed an imperforate 
hymen, or atresia of the hymen, the former term being 
applicable to the case which is congenital, and the latter, 
when it has resulted from inflammation. 

The congenital imperforate hymen is the only variety I 
can find mentioned by any author; but I have had two 
cases of acquired atresia of the hymen, so that I know this 
condition may exist occasionally independently of congenital 
abnormal development. These two cases developing after 
menstruation had become established, lead me to suspect 
that some other cases, which are, of course, only discovered 
at puberty, may have been acquired in girlhood. 

The two cases referred to were patients of my own; 
one was seen and examined by the late Dr. M. Troyer, 
of Peoria, Illinois, who, after the most thorough examination 
with the unobstructed eyesight, and the use of a probe, con- 
firmed my diagnosis. The other similar case no physician 
examined but myself. Both had menstruated regularly, and 
had been troubled with leucorrhoea.and soreness. Menstrua- 
tion was arrested in both cases, had at first diminished in 
quantity and finally ceased. One had not menstruated for 



198 EATON ON DISEASES OF WOMEN. 

four months, the other for seven ; both had serious symptoms 
of lung disease, accompanied with poor appetite, bad diges- 
tion, and considerable emaciation- — one was about eighteen, 
the other twenty-three years of age. The hymen in both 
cases was exceedingly tough, and about as thick as sole 
leather. There was a considerable accumulation of retained 
menstrual flow in one case, and but very little in the other. I 
operated on both cases with the result of restoring the gen- 
eral health and the re-establishment of the catamenia. Both 
are still healthy. One has married and has three children; 
the other is well, robust, and fleshy, with no evidence of 
lung trouble. 

I judge from the history of these cases that inflamma- 
tion of the vagina and hymen had caused a thickening of the 
membrane, and granulations had gradually closed up the 
openings, which probably had been small originally, and were 
certainly cases of acquired imperforate hymen. 

It is usual in cases of congenital imperforate hymen that 
after the adult age, the menstrual flow being retained in the 
vagina, causes a bulging outwards of the membrane, and 
usually produces serious disturbance of the general health. 
This retention of blood in the vagina and uterus is called 

H^MATOMETRA. 

In these cases the menstrual secretion is discharged into 
the vagina, and may, for a time, cause no very serious conse- 
quences, though often causing pain in the pelvis, and a sense 
of weight and tenderness. Gradually, as month after month 
passes, and the flow is increased and still retained, the suffering 
is greatly increased, and the general health suffers in a marked 
degree. Generally Emenagogue medicines are administered by 
physicians, and the mother uses all the domestic remedies 
she knows of or can hear of, and the poor girl suffers on 
without relief, because the cause of the amenorrhcea is not 
discovered. 



HsEMA TOME TRA. 199 

This is a sad picture, but a true one, as the remedies often 
used by the old school for amenorrhoea are powerful. 

In homoeopathic practice the effects of the remedies usu- 
ally given are less deleterious, but still of no avail in rem- 
edying the difficulty when caused by an imperforate hymen. 

In cases of this kind, combined with absence of the ova- 
ries, where attempts at copulation have been made, the hymen 
has been pushed up into the vagina, and has been mistaken 
for atresia of the vagina, as there was no menstrual fluid to 
press the hymen down. 

This class of cases, however, is exceedingly small. The 
physician can not suggest making even a digital examination 
of girls affected with amenorrhoea, until remedies have been 
given and proven inefficient; and not then, unless the age of 
the patient and her sufferings point clearly to something ab- 
normal in the physical development. There is delicacy, tact, 
and judgment to be used in these cases. But the patient 
should not be allowed to suffer and die from excessive mod- 
esty and backwardness in ascertaining the true nature of the 
difficulty. 

Treatment. 

As has been suggested in the description of this disease, 
medicines are of no avail. A resort to an operation is impera- 
tively demanded. It consists in making a free incision into 
the hymen by first inserting a sharp-pointed bistoury, and 
then inserting a grooved director, to aid in slitting the entire 
membrane. Through this slit the retained menstrual secre- 
tion should be freely evacuated, and the vagina thoroughly 
cleansed with soap and water, followed by carboiized water; 
then smear the whole of the interior of the vagina with vas- 
eline, and insert a vaginal dilator of medium size, and retain 
it there with a T bandage. It is usually best to operate 
with the patient under an anaesthetic ; but it is not always 
necessary, as I have found from experience. Still I rather 
prefer the patient be insensible to the pain of the operation. 



200 EATON ON DISEASES OF WOMEN. 

Every day, until the parts heal, it is necessary to remove 
the dilator, wash out the vagina, and replace the instrument ; 
but if we use an open cylindrical speculum for the dilator, it 
may be allowed to remain for three or four days, washing out 
the vagina with carbolized, lukewarm water, through the spec- 
ulum, once or twice daily. 

Remedies may now be given with excellent effect, chosen 
in accordance with the totality of the symptoms. Usually 
Puis., CaL carb., Ars., or China are indicated. Nourishing 
diet and fresh air are indispensable. 

It is true, any number of sympathetic symptoms may 
arise in such cases, hysterical and otherwise, which may be 
met with indicated remedies; and we can expect that they 
all will pass away upon the cure of the difficulty in the hy- 
men, causing the retention of menstrual flow, which has poi- 
soned the blood, from its reabsorption and decomposition. 

Ramsbotham, Simpson, and Le Fort report cases terminat- 
ing fatally from small puncture of the imperforate hymen, 
which allowed of the admission of air, decomposition of 
the retained blood, and septicaemia following. Free incision 
and cleansing should be the rule, in order to prevent this 
result. 



UTERINE HEMORRHAGE. 201 



CHAPTER XVIII. 

UTERINE HEMORRHAGE. 

The term uterine hemorrhage is applied to an abnormal 
and excessive loss of blood from the uterus. This includes, 
of course, menorrhagia. It means menorrhagia, and more 
than this, also s . It may occur during the course of gestation, 
or otherwise. It may occur independently of the menstrual 
function caused from some irritation within the uterus from 
tumors. It may supervene upon delivery. It may be caused 
from ulceration. It may induce and be caused by an atonic 
or anaemic condition of the system. 

Hence, we see that uterine hemorrhage needs to be thor- 
oughly studied ; for a clear understanding of the cause of the 
hemorrhage is often of the utmost importance in regard to 
the treatment of the case. 

I have discussed the hemorrhage caused from uterine 
tumors under that head, and excessive menstruation under 
the head of menorrhagia; still there are many other condi- 
tions which may cause hemorrhage from the womb, and to 
these conditions I invite attention. 

First, the accidental hemorrhage, occurring during gesta- 
tion, caused from a partial separation of the placental attach- 
ment. Sometimes this flow simulates regular menstruation, 
and the patient does not imagine herself pregnant at all, 
and often indignantly repels the intimation. I have seen 
several cases of this kind. I will relate one case as some- 
what typical. 

In May, 1863, I was called to see Mrs. D., aged fifty- 
three years, who had been flowing, she told me, almost daily 
for five months, and that once a month the flow was exces- 



202 EA TON ON DISEASES OF WOMEN. 

sive, accompanied with some uterine pain. This time being 
one of her monthly flows, I found her apparently having 
some pain in the uterus, though flowing freely. I learned 
from her that the menses had about eight months before 
ceased for about three months, since which time they had 
been as stated. I requested a vaginal examination, which 
she at first refused, thinking it quite unnecessary, but she 
finally consented, and I found the os uteri open, the size of 
a dime or more, and through it I could feel something pre- 
senting. I tamponed the vagina and gave Secale cor. This 
increased the pain, and in two hours I removed the tampon 
and found a foetus half-way through the os. This I ab- 
stracted, which greatly astonished the patient and her 
friends. She made a rapid recovery. In several instances I 
have had a similar experience with women in their first 
pregnancies, and at other times. 

Etiology. 

After confinement, and after a miscarriage, women often 
suffer from severe floodings. This may be due to the reten- 
tion of a part or the whole of the placenta, or after labor to 
a failure of contraction of the uterus, leaving the blood- 
vessels dilated where the placenta had been detached. I 
have many times been called to see patients who were flow- 
ing excessively after an abortion, and their physician either 
failed to realize the cause or was unable to use the means 
for relief. These cases are very trying, as it is generally 
the case that both patient and friends, and sometimes the 
physician, insist that "all has come away." They are gen- 
erally led into the error by mistaking a large clot for 
the placenta. 

We may lay it down as a rule that in miscarriage there 
is never excessive hemorrhage after the foetus and placenta 
are discharged. If active, troublesome hemorrhage super- 
venes after abortion, we know something is still retained, 



UTERINE HEMORRHAGE. 203 

During the first few hours there may be an excessive flow 
from relaxation of the muscular tissues of the uterus, and a 
condition of sub-involution of the organ, these conditions 
leaving the veins open and liable to bleed, as is also the case 
in some instances after labor at term. 

The only safety from hemorrhage lies in the full, perfect 
contraction of the uterus, following the delivery of the child, 
or foetus, and the placenta, or membranes. Careful attention 
should be given to the complete discharge of the membranes 
after abortion, as their retention in the uterus may cause 
hemorrhage from the efforts of the uterus to dislodge them, 
alternately contracting and relaxing. During the period 
of relaxation the blood is effused into the uterus, and ex- 
pelled with each contraction, until the membranes are entirely 
expelled. 

Hemorrhage may result from intra-uterine fibroids, uterine 
polypi, granulations of the endometrium and cervix, uterine 
hydatids, mucous polypi in the uterus, inflammation of the 
cervix, cauliflower excrescence, and cancerous ulceration. 

Most of these conditions I have spoken of under distinct 
heads, and the reader is referred to them for description, 
etiology, and treatment. 

In some persons there is a certain predisposition to 
hemorrhage, called a hemorrhagic diathesis ; and there is in a 
few this tendency to hemorrhage, without the outward 
manifestations of any peculiarities characteristic of this dia- 
thesis. 

The hemorrhagic diathesis is marked by the light complex- 
ion; thin, rosy skin; the lymphatic temperament; the large, 
languid eye; the slow, compressible pulse; the languid man- 
ner, etc. These symptoms, more or less, indicate the nerve 
weakness, upon which, it is probable, the whole difficulty de- 
pends. Want of tonicity or strength in the nerve, giving 
rise to relaxation of the veins and capillaries, allows of the 
bursting out of the blood from its natural channels by first 



204 EATON ON DISEASES OF WOMEN. 

allowing of distension, and, there not being power enough 
in the coats of the vessels to withstand the pressure, a lacer- 
ation of their coats is the result, and a hemorrhage ensues. 

An extremely liypercemic condition of the system may 
largely tend to the production of this diathesis in causing 
distension and consequent weakening of the blood-vessels, 
and causing the nerve depression, to some extent, by the 
pressure exerted upon the brain from over-fullness of the 
blood-vessels there. This peculiar condition may be acquired, 
or may be inherited. It is sometimes manifested through 
several successive generations. 

When there is in a patient this peculiar predisposition, 
of course, she is liable to hemorrhage from causes which 
would produce no effect in others. Recognizing this predis- 
position, we may use such preventive treatment, many times, 
as will prevent the occurrence of hemorrhages, which other- 
wise might be severe, or even fatal. ("The time will come 
when the people will depend as much upon the physician to 
prevent diseases as they now do to cure them.") 

The causes of uterine hemorrhage, which are general in 
their application, consisting of the atonic and hyp.ergemic con- 
dition, conjoined with the lymphatic temperament, which we 
mentioned, are supplemented in uterine hemorrhage in 
pregnancy by certain other causes which operate directly to 
produce the hemorrhage. 

First, the partial separation of the placental attachm 
to the uterus is the direct use of the hemorrha^-. 
mav result from straining. lifting, m fright, from a fall or 
*r from the contractions ;f an irritable womb, 
independently of these causes. 

The attachment of the placenta dire L r ;:" 

the uterus, calle " " causes I emorrb _ t ; for 

s th € '; : v of the uterus expands it brc ks »ff portk rf 

the attachment, and hemorThrjr results often only in nnaD 

7 . and is discharged per vaginam. 



UTERIXE HEMORRHAGE. 205 

The inertia of the womb causes, in some cases, sub-involu- 
tion of the organ, and may result in hemorrhages for months, 
generally occurring at the menstrual periods, and properly 
termed menorrhagia. 

Diagnosis. 

Of course, the discharge of blood per vaginam is the usual 
symptom of uterine hemorrhage, being at a period uncon- 
nected with menstruation, or protracting that event, and being 
excessive in quantity at the regular period. If of small amount 
only, when not connected with menstruation, it constitutes a 
hemorrhage. 

A blanched countenance, white lips, coldness of the ex- 
tremities, feeble pulse, etc., are symptoms of excessive hem- 
orrhage, and may or may not be accompanied with fainting 
spells. When fainting comes on, the flow of blood is gen- 
erally arrested temporarily. 

Sometimes uterine hemorrhage may go on to a considera- 
ble extent without blood being discharged per vaginam, being 
retained by clots in the vagina or os uteri. This is particu- 
larly the case in post partem hemorrhage ; the uterus, having 
failed to contract, may become distended with blood, and very 
little pass from the patient, producing all the alarming symp- 
toms enumerated. And occasionally this may occur after the 
uterus has contracted, apparently quite well, slight hemor- 
rhage at first, forming a clot at the os. As the blood contin- 
ues to ooze out, the uterus relaxes, the blood-vessels open, 
and the hemorrhage becomes rapid, and the patient manifests 
alarming symptoms, first noticed, perhaps, by the occurrence 
of a faint, and our attention is then called to the other symp- 
tom of hemorrhage, and, on examination of the uterus, it is 
felt distended to about the size it was before delivery. 

Treatment. 

The first thing to be done in uterine hemorrhage is to take 
such action as will at once arrest the flow of blood. In jtost 



206 EATON ON DISEASES OF WOMEN. 

partem hemorrhage the first thing to do is to turn out the clots 
in the vagina, and, if the uterus does not then contract, we 
should pass the fingers within the os, and remove all the 
clots from it. If this is not effectual, pass the whole hand 
within the uterus, and break up the clots, and gently move 
the hand around the sides of the cavity of the womb, apply- 
ing the other over the abdomen, and using gentle friction with 
the extended palm. It is well at first to administer a half 
ounce of brandy, with a half-teaspoonful^of Flu. Ext. of Ergot 
in a little warm water. 

If these remedies and means fail, take a Davidson's syr- 
inge, and inject into the cavity of the womb a quart or two 
of very warm water, and in a half hour give another dose of 
brandy, and follow it with the Secale in fifteen minutes, if 
the uterus does not contract. In the most extreme cases we 
may apply the Persulphate of Iron directly to the intra-uterine 
surface, by means of a sponge attached to a sponge-holder, 
and swab it out in that way. An evenly applied bandage 
should be tightly applied about the abdomen, to give support 
to the abdominal muscles, and aid in the holding of the uterus 
in a state of contraction. The application of ice to the abdo- 
men, and introducing pieces of it into the uterus, tends to 
shock the system too severely, as well as chill the patient, and 
induce inflammation. The trusting to a single dose of Bell. 
200 x , or Ipecac. 30 x , which has been claimed by some to be 
efficient, I have never tried, and can not recommend from 
personal experience. 

After the hemorrhage has ceased I have given Ipecac. 3 X , 
or 6 X in some cases to prevent recurrence of the flooding, 
apparently with good effect. China, Secale, Nux, or Ars. are 
sometimes indicated. Should the hemorrhage precede the 
delivery of the child, every effort should be made to deliver 
as rapidly as possible. If the os is not dilated, it and the 
vagina may be tamponed, which would restrain the flow till 
the os is dilated so that artificial delivery can be attempted 






UTERINE HEMORRHAGE. 207 

and effected, while subsequent to the delivery the tampon is 
inadmissible, as restraining the flow externally to the uterus 
would not prevent the hemorrhage going on actively into the 
cavity of the organ, as has been before stated. While the 
child is still in the uterus its presence would compress 
the bleeding vessels from above, while the clot formed from 
the use of the tampon below would restrain the flow and 
keep it under restraint. 

In cases of hemorrhage preceding and threatening abor- 
tion (if excessive) we may use the tampon. (The inflatable 
rubber bag, with tube and stop-cock, is the most convenient 
means.) If the flow is slight I would give Secale 3 X every 
two hours, and order perfect rest in the recumbent posture, 
following the arrest of the hemorrhage with such remedies as 
seemed to be most indicated in each case. 

If the foetus has been expelled and flowing is going on 
severely, we must see to it that the placenta (or membranes) 
is removed, whether the case is one of a few days' or five 
months' duration. I have removed one where it had been 
retained for seven weeks after the delivery of a foetus, 
causing almost daily hemorrhages. The patient's physi- 
cian (though of the most regular kind, and in excellent 
standing) had failed to realize that the placenta was retained ; 
still at my first visit I removed it, and the patient had no 
more hemorrhage and rapidly recovered. So the great length 
of time a hemorrhage has continued must not prevent us 
from seeking for a retained placenta, if the hemorrhage dates 
from the time of the miscarriage. 

• To remove a placenta retained after a miscarriage, I 
pass within the uterus an ordinary uterine sound considerably 
curved, and gently sweep it around the cavity of the uterus, 
and by this means detach that portion of the placenta which 
is adherent — very often uterine contractions are induced by 
this procedure. If so, very well; if they are not, I would 
give about twenty drops of Flu. Ext. of Ergot in a little warm 



208 - EATON ON DISEASES OF WOMEN. 

brandy and water, every twenty minutes till contractions 
ensued, or until three or four doses have been given ; some- 
times the long, slender placenta forceps, or the uterine polypi 
forceps, can be introduced, and greatly aid us in extracting 
the placenta. 




Fig. No. 20 — Greexhalghs Forceps. 



In some cases when the blood flows freely from the 
vagina, following the expulsion of a foetus, it may be best 
to at once tampon the vagina and allow the blood to fill the 
uterus, which, being of small size, would not endanger life, 
and which, by its presence, may stimulate uterine contractions 
of so strong a character as to detach the placenta and force 
out both placenta and clots. Warmth is to be applied to the 
feet in these cases, and the lower limbs and body should be 
kept warm with covers of flannel. 

In case there was a fibrous polypus in the uterus of 
some size, causing the hemorrhage after abortion (which is 
almost an unknown instance, as pregnancy will seldom occur 
in a womb Occupied with a polypus, nor will the polypus de- 
velop very often, if ever, after pregnancy has occurred), we 
will be likely to discover it in our exploration with the 
sound, used to detect and dislodge the placenta, in which 
case it is to be treated by as rapid removal as possible, on 
the general plan of treatment mentioned under the head of 
uterine polypi. 

These cases do not suffer much from pain, and, conse- 
quently, we have few pain symptoms to aid us in selecting 
remedies. We must look to the pulse, the countenance, the 
general system, as well as the hemorrhages themselves, for 



UTERINE HEMORRHAGE. 209 

indications for remedies. Aconite, Bell., Ipecac, Secale, Hydras- 
tis, Nux, Plumb., Opi., Merc, Ars., Puis., etc., are to be 
studied in these cases, and given, according to the symptoms 
homoeopathic to them. 

In cancerous ulceration producing hemorrhage, and in 
cases of inflammation of the cervix, vegetations of the endo- 
metrium, uterine tumors, etc., I refer the reader to these 
special diseases. 

The hemorrhagic diathesis is to be treated according to 
the prominent indications in each case. Nux, Ignatia, Ars., 
Bry., Rhus, etc., which act to tone up the general nervous 
system, are indicated, sometimes including such remedies as 
Phytolac, Col. carb., Sulph., Can. ind., lod., Kali iod., etc., 
with reference to the glandular system. These cases are 
often troubled with epistaxis, and free hemorrhage results 
from very slight wounds. In these cases Ave may, with 
advantage, also study Trillium, Cimicif. rac, and Erigeron, 
which have proven highly beneficial in a disposition to 
hemorrhage, when otherwise indicated by the accompanying 
symptoms. 

Rest and Position. — The pregnant woman, attacked even 
with slight hemorrhage, should at once assume the recumbent 
posture, and remain quiet. The mind must not be agi- 
tated by care or conversation. If the attack is severe the 
patient should lie with the limbs and hips elevated, and the 
head resting upon a small pillow. Do not raise up the 
patient because she is faint, but lower her head and raise 
the body and limbs. In connection with this care as to rest 
and position, the patient should take Secale cor., 6 X or 12 x , 
every two or three hours. (The value of this remedy in 
minute doses, to prevent threatened abortion and premature 
labor, is now recognized by the old school also, which is a 
recent concession to homoeopathy in them.) After the flow 
has been arrested two or three days the patient may be 
allowed to sit up a little, and very soon take gentle exer- 

14 



210 EATON ON DISEASES OF WOMEN. 

cise, but no hard labor or riding over rough streets should 
be allowed. Sexual congress must be strictly prohibited in 
these cases. 

Diet. — The diet must be as nutritious and easily digested 
as possible. Stimulants are, as a rule, injurious, except in 
cases of excessive floodings, when wine may be given tem- 
porarily, but not continued after the urgent symptoms are 
relieved. Milk, with a little salt, beef tea, soup, etc., are de- 
manded to replenish the blood. The patient should be 
allowed to drink cold water freely, but she is better off 
without tea and coffee. Giving to the patient candies, cakes, 
pies, etc., is injurious. Let the food be plain, easily 
digested, and consisting largely of farinaceous materials. 
Much care needs to be exercised by the physician in regard 
to diet in all the diseases of women, but it is especially 
necessary in hemorrhage, as the system is drained of a large 
amount of this vital fluid, and it must have resources from 
which to gain a new supply. 

Am and Light. — Give the patient fresh air to breathe, 
and some of God's sunlight to look at. The effect of a dark 
room and stagnant air is so depressing that we do well to 
avoid both. 



CERVICITIS AND ENDO-CERVICITIS. 211 



CHAPTER XIX. 

CERVICITIS AND END 0- CERVICITIS, OR CATARRH OF THE 

CERVIX. 

Cervicitis indicates inflammation of the neck of the uterus, 
affecting its entire substance. Endo-cervicitis indicates in- 
flammation simply of the mucous membranes lining the cervix 
uteri. 

Areolar hyperplasia of the cervix may simulate,, and also 
be the result of, cervicitis. 

Endo-metritis may or may not exist in connection with 
cervicitis or endo-cervicitis. 

Endo-cervicitis is one of the most frequent diseases of 
young women, and in the recent acute attack is often termed 
catarrh of the cervix, or catarrh of the uterus. 

Virgins are more liable to this disease than any other 
affecting the genital organs, and we often find it in old women 
after the climacteric period is passed. We would not intimate 
that middle-aged women are free from these diseases; far 
from it. Endo-metritis is, however, more common with them 
after they have born children. Cervicitis, on the contrary, 
is seldom found in the virgin or in women after the climacteric 
period, but is quite common in the child-bearing woman. 

Cervicitis and endo-cervicitis may be either acute or 
chronic. 

Diagnosis. 

The most prominent indication of the existence of these 
diseases is a leucorrhoeal discharge from the vagina; and, upon 
examination with the speculum, we find that the discharge is 
coming from the os uteri. On attempting to introduce the 



212 EATON ON DISEASES OF WOMEN. 

uterine sound, we find tenderness often to so great an extent 
as to forbid the completion of the examination. On intro- 
ducing the sound to the fundus of the womb, we find it 
normal in size, measuring, in the virgin, about two and a half 
inches, and in those who have born children, about three 
inches. (If we find enlargement of the size of the uterine 
cavity, we may know that we have endo-metritis, intra-uterine 
tumors, or a case of sub-involution.) This discharge from the 
cavity of the uterus varies greatly in appearance and quan- 
tity. Sometimes it is white and milky, sometimes yellow, 
sometimes green, and sometimes mixed with blood. Press- 
ure over the hypogastric region produces little or no pain 
in cases of endo-cervicitis, uncomplicated with metritis or 
other troubles. The constitutional disturbance is, however, 
well marked, but is not distinctive of this disease, but consists 
of those symptoms peculiar to almost any disease of the 
genito-urinary organs. If any thing, restlessness is more 
marked than other symptoms. The patient is never satisfied 
to be still, is fretful about she knows not what. This is prob- 
ably occasioned by a sense of irritation, she knows not where; 
but feels sure either the world, the people, or something is 
all w T rong. 

Very often this disease is mistaken for vaginal irritation 
by the physician (on account of these symptoms, and not 
having made a, physical examination), and, consequently, the 
treatment has failed, and this is an additional cause for the 
patient to feel annoyed at the continuation of the leucorrhoeal 
discharge, which, it seems to her, should be at once cured 
with one prescription. She will, therefore, go from one phy- 
sician to another, with about the same success. 

Barrenness, if she be married, is another result, which 
often causes much dissatisfaction, and it is little likely that 
conception will occur in a case of endo-cervicitis. Hence, if 
we have barrenness with leucorrhcea, we may mistrust at 
once a case of endo-cervicitis. Partial amenorrhoea, dys- 



CERVICITIS AXD ENDO-CERVICITIS. 213 

menorrhcea, or menorrhagia may also lead us to suspect this 
disease. 

But the positive diagnosis vests in the specular examina- 
tion, revealing the lips of the os of a bright red color inter- 
nally, and the leueorrhoeal discharge coming from the os, with 
the tenderness on introducing the sound, as well as the flow 
of blood often produced by its introduction, however gently 
it may be done. 

In cervicitis there is present all these symptoms, indicat- 
ing endo-cervicitis, and, in addition, enlargement and tender- 
ness of the cervix, usually accompanied with some fever, 
sense of weight in the pelvis, often constipation and painful 
micturition. In these cases the gentle touch of the finger 
causes pain if the disease be acute, and she tells us copula- 
tion is extremely painful or impossible. 

Etiology. 

The causes of these diseases are various, and sometimes 
unexplainable. Cold at the menstrual period is probably the 
most frequent in the unmarried, producing a catarrhal condi- 
tion of both vagina and uterus ; or, in some instances, first 
affecting the vaginal mucous membrane, and extending to 
the uterine; in other cases, attacking the uterine cavity first. 
The cold taken when the vessels of the uterus are engorged 
with blood, and the mucous membrane is in a state of con- 
gestion, produces, usually, an arrest of the catamenia; and 
the retention of the menstrual fluid tends to produce irrita- 
tion. The first condition produced is that of dryness, fol- 
lowed by exudation of the serum of the blood, which, after 
a time, gives place to the thick, mucous discharge. Again, 
perhaps a cold is taken, the case is neglected, and Ave have 
a fully developed case of endo-cervicitis almost immediately. 
In other cases, the cause seems to be in the debilitated con- 
dition of the system, aided by a very slight cold. 

After miscarriage we have endo-cervicitis, resulting some- 



214 EATON ON DISEASES OF WOMEN. 

times from an imperfect separation of the placenta; and we 
have cervicitis resulting from imperfect involution of the 
uterus after confinement. Again, the careless use of the 
sound; or the introduction into the cervix of instruments to 
produce abortion; or the injections of irritating fluids into 
the uterine cavity, either accidentally or designedly; also, 
the use of cold washes into the vagina, immediately after 
copulation, to prevent conception, all tend to cause endo- 
cervicitis. The presence of uterine polypi, fibroids, hyda- 
tids, etc., by their presence, tend to produce this .disease; 
but it is with special reference to the uncomplicated form 
of endo-cervicitis and cervicitis that I am now speaking. 

Lacerations of the cervix uteri, in confinement or other- 
wise, tend directly to cause these diseases. These fissures 
do not always heal readily, and cause much irritation to the 
surrounding tissues. When these lacerations heal kindly, 
there is left somewhat of a cicatrix, which must cause (more 
or less) a tendency to irritation of the cervix, producing 
cervicitis, endo-cervicitis, or areolar hyperplasia of the cervix. 

Treatment. 

Generally, we are not consulted in these cases till they 
become chronic; or, if we are consulted in the acute attack, 
we prescribe on general principles without making a vaginal 
examination; hence, we may often cure acute attacks of 
endo-cervicitis without being able (without examination) to 
specifically diagnose the case, more than to call it inflamma- 
tion of the womb, or vagina; or to call it cold, catarrh, or 
something of the kind, as no lady expects to have a vaginal 
examination made in ordinary acute attacks, especially if the 
symptoms are not severe, which they are not, usually, in this 
disease, unless the inflammation extends to the muscular 
tissue, lining membrane, or peritoneal coats of the womb 
also, when, of course, technically, the case should be called 
metritis, endo-metritis, or peri-metritis, with endo-cervicitis. 



CERVICITIS AND ENDO-CERVICITIS. 215 

If we are so fortunate as to see the case in its inception, 
the warm sitz bath, with warm foot bath, should at once be 
prescribed, with Aconite every one, two, or three hours, ac- 
cording to the urgency of the symptoms. 

In the chronic form of the complaint, the remedies most 
useful are Cal. carb., Sepia, Phytolac, Sulph., Merc., Kali 
iod., etc. 

But we find that some local treatment is sometimes nec- 
essary. The introduction, daily, into the cervix of tents of 
cotton, saturated with Bell, and Glycerine, equal parts, or 
Hydrastis and Glycerine, or Glycerine alone, or Glycerine and 
Iodine, or Solu. Iodine, using the two latter prescriptions in 
cases where there was little tenderness, but much discharge. 
The sea-tangle tent or even slippery-elm tent may do good 
service; or we may fully dilate the cervix, so as to admit 
the finger to the fundus, and then apply Solu. Iodine, five 
grs. to the ounce (see Fig. No. 11, on page 150), or we may 
use Hydrastis tr. and Glycerine instead. This plan has 
proven efficient in my hands for years, and I propose to 
write in this work mainly my own experience in treatment. 

Caustic applications I must warn the reader against. 
Never use them. They are unnecessary, and often very inju- 
rious, producing peri-metritis, sloughing, and, in some cases, 
atrophy of the uterus, as well as atresia of the cervix uteri. 

The use of carbolized ointment with the sound, or Sup- 
positories of Hydrastis, Bell., or other remedies, are often 
highly beneficial, allowing them to remain in the cervix till 
they dissolve. 

The application may be made directly to the neck of 
the uterus, either of Glycerine or Glycerine and Hydrastis, 
equal parts, or of a solution of Iodine l x ; or we may use the 
l x attenuation of Comp. tr. Iodine with camel hair pencil; or a 
dossil of lint, moistened with a little of the medicine, may be 
gently pressed against the os through a speculum, always 



216 EATON ON DISEASES OE WOMEN. 

attaching a string to the cotton to facilitate its removal. 
These applications may be made daily or once in two or 
three days in some instances. 

The tents by their pressure seem to act beneficially in 
repressing the capillary circulation in the mucous membrane 
of the cervix. In case of tumors, of course, all treatment 
will be simply palliative until the exciting cause is removed. 
In this, as in other affections, a careful avoidance of the 
exciting cause is to be strictly enjoined. 

Intra-uterine injections I do not recommend, as the meth- 
ods I have suggested are efficient and less hazardous. Some 
physicians use them, however, satisfactorily. If any one 
should desire to try them, I warn them to be extremely care- 
ful of the temperature of the fluid used, as uterine cramps 
are a common result of the use of intra-uterine injections of 
low temperature. Caution is also necessary to use but a 
small amount, and to use it with the intra-uterine syringe, 
with a bulb on the tube about one and a quarter inches from 
the end to prevent its entering the uterus too far, and with an 
elastic air bag at the other extremity. The method of its 
use is as follows : Compress the air-bag to expel all the air, 
then insert the tube into the fluid we intend to inject; open 
the hand and allow the bag to expand, which will, by atmos- 
pheric pressure, cause the fluid to rise into the bag; then hold 
the tube upwards to let any air escape that may be in the 
bag; gently press the bag while the tube is elevated till the 
fluid begins to be expelled from the tube ; then, while still 
holding the bag in the same state of compression, insert the 
tube into the os up to the bulb before mentioned, when we 
may compress the rubber bag gently till some of the fluid is 
pressed into the uterine cavity; then open the hand and allow 
the bag to expand, which will draw back a considerable 
amount of the fluid into the syringe again, when it may be 
withdrawn. 



CER VIC IT IS AND END O- CER VIC IT IS. 2Y1 

Results. — Granulations of the cervix and in the uterine 
cavity, as well as uterine polypi and sterility, are likely to 
result from endo-cervicitis. The inflammation may extend to 
the muscular or even peritoneal coat of the uterus, caus- 
ing what is termed peri-metritis. In rare cases pregnancy 
takes place, but miscarriage is likely to result. 

Indications for Remedies. 

Aconite — is indicated in acute attacks of endo-cervicitis, 
where there is present fever, with a rapid, wiry pulse, fear 
of death, thirst, etc. 

Ars. Alb. — Restlessness ; congestion ; nausea ; chilliness, 
alternating with heat, weakness, diarrhoea, etc. 

Bell. — When the face is flushed, the patient complains 
of bearing down pains, painful straining in micturition, dull 
headache, etc. 

Bryonia. — Worse towards evening; sharp pains in the 
pelvis, or other parts of the body; worse on motion. 

Bovista. — Ill-humor: drowsiness; thick, slimy leucor- 
rhoea, etc. 

Cal. Carb. — Great prostration in chronic cases ; leucor- 
rhoea like milk; feet cold and damp. 

Merc. cor. — Worse at night; prostration and dryness of 
the mouth, with thirst; leucorrhoea greenish. 

Phytolac. dec. — In chronic cases where there is gland- 
ular enlargement in scrofulous patients. 

Sepia. — Profuse milky leucorrhoea, with irritation of the 
mucous membranes generally. 

Sulph. — The discharge from the vagina is offensive. 



218 EATON ON DISEASES OF WOMEN. 



CHAPTER XX. 

END O - ME TRITIS. 

Endometritis indicates an inflammation of the lining 
membrane of the entire uterus, and in conjunction with it 
inflammation of the sub-mucous tissue of the organ gen- 
erally. Undo -metritis may be acute or chronic. It produces 
a more profound impression upon the general system than 
endo -cervicitis. 

Endometritis, with some metritis, is perhaps the most 
common disease of women to-day. I may safely say they 
come under the care of the general practitioner almost daily. 
I will not say they are always recognized ; on the contrary, 
chronic endo-metritis is very often overlooked. It produces 
so many sympathetic affections, that they are very often 
mistaken for the disease, and the real ailment is lost sight of. 
The inflammation may be confined to the neck of the uterus, 
when it is termed endo-cervicitis, cervical metritis, or cervical 
endo-metritis, to distinguish it from endo-metritis, which indi- 
cates the affection of the fundus as well. 

It may be impossible to diagnose a slight irritation of the 
peritoneal covering, but if the irritation of this membrane is 
considerable, it will extend so as to be easily diagnosed as 
peri-metritis. Inflammation probably most frequently com- 
mences in the mucous membrane, and extends to the sub- 
mucous cellular tissue, and then to the muscular, but this is 
hard to demonstrate. It may commence in the fibrous or 
peritoneal tissue. 

The body of the uterus is most frequently the seat of the 
disease, causing engorgement of the vessels and consequent 
enlargement of the entire organ. In some instances the 



ENDO -METRITIS. 219 

neck seems to be primarily affected, and the inflammation 
then extends to the body, and, in some instances, the lining 
of the fundus of the uterus is alone affected. 

Diagnosis. 

Very many times we have vaginitis in connection with 
endo-metritis; hence, when we find vaginitis present, we 
must not rest satisfied till we are sure we have not endo- 
metritis, causing the vaginitis, from the irritating qualities of 
the discharge from the cervix. On making a digital examina- 
tion we find the os enlarged, tender, patulous, with the mu- 
cous membrane covering the neck of a somewhat brighter 
color than natural. Tenderness is present on attempting to 
introduce the uterine sound. The sound will reveal to us 
some increase in size of the uterine cavity. Sometimes this 
increase of size is considerable ; in other cases, slight. 

Hypertrophy. — The hypertrophy may be general, affecting 
the entire organ, or the cervix may be enlarged and the body 
remain normal in size. With this enlargement of the cervix 
we may have induration, the neck generally uneven, though 
sometimes smooth. Rarely we have induration with an atro- 
phied condition of the uterus. The term hypertrophy is not 
applicable in some cases, especially where we have effusion 
of fibrinous material into the submucous tissue, giving rise to 
the soft, patulous feel, and which organizes after a time to 
produce the hardness mentioned as induration. (See Areolar 
Hyperplasia of the Uterus.) 

In hypertrophy we have an enlargement of all the tissues 
of the organ, similar to the condition in sub-involution. Hy- 
pertrophy and induration are to be considered as results of 
chronic metritis, with endo-metritis. 

Though we may have enlargement, in cases of acute or 
chronic metritis, the extreme tenderness of the organ, the 
suddenness of the attack and the accompanying fever, wiry 
pulse, etc., will clearly indicate the acute form. The sub- 



220 EATON ON DISEASES OE WOMEN. 

acute or chronic endo-metritis, with metritis, presents some 
tenderness of the organ, but not as severe as in the acute 
variety. The history of the case will also throw some light 
on the diagnosis. 

By introducing the index finger of one hand into the 
vagina till it touches the os uteri, and then pressing the other 
down on to the uterus from above in the lower hypogastric 
region, we may determine the amount of tenderness in the 
organ. The amount of the leucorrhoeal discharge is not an 
index to the severity of the disease, as in cases which show 
the most tenderness we may have little discharge, and vice 
versa. 

Color of the Discharge. — The thick, yellow discharge 
indicates some exfoliation of the cervical mucous membrane, 
unless it be in cases following after a miscarriage or labor, 
indicating a suppuration or sloughing of some small portion 
of retained placenta, or that the endometrium has been left 
raw and suppurating; or we may have decay of a polypus, 
causing this yellowish white suppuration. The thin, slimy, 
mucous discharge only indicates an excess of natural secretion 
of the mucous membrane, and will indicate very little trouble 
in the endometrium or cervix. In the healthy condition of 
the parts there should be no discharge from the vagina, except 
the menstrual fluid, or, in case of excitation of the sexual 
passion, when there is an increase of the vaginal mucus, 
which may flow away in considerable quantities during the 
continuation of the excitement. 

Uterine Tenesmus — Bearing Down. — The patient suffering 
with endo-metritis will almost always suffer from a sense of 
weight and bearing down in the pelvis, and sometimes the 
pain is so intense as to simulate labor. In such cases of se- 
vere pain we have reason to suspect that there is some foreign 
growth in the uterus, either fibroid or polypoid, especially if 
the pains are intermittent. But the sense of weight and 
pressure is a common symptom of endo-metritis, in all cases. 



ENDO-METRITIS. 221 

This symptom is the more prominent if the patient stands 
much on the feet. Standing will produce more pain, ordi- 
narily, than walking, as in standing the weight of the abdom- 
inal viscera rests more directly upon the uterus, and aids in 
depressing it as well as to produce the sense of soreness. In 
walking, the body is thrown from side to side alternately, so 
that the weight of the bowels rests more on the brim of the 
pelvis, and, consequently, produces less suffering than stand- 
ing. It is often the case that even a small amount of walk- 
ing can not be endured ; but the patient has to lie in the 
recumbent posture, with the hips elevated. 

It must not be thought that these cases require ordinary 
treatment for prolapse or other displacements. Generally we 
will detect little prolapse while the patient is in the recum- 
bent position; still, while she is standing, the uterus will be 
usually lower than normal in the pelvis ; but this will be rec- 
tified as the inflammation subsides and the engorgement and 
weight are removed. The amount of pain complained of is 
owing as much, or more, to tenderness as to displacement. 
The pain produced in some cases seems out of all proportion 
to the severity of the case as revealed by physical examina- 
tion, and is to be explained in the more highly sensitive ner- 
vous organizations of some women than others. 

Pain in the Loins. — Pain in the loins is also a distress- 
ing symptom in some cases. This is caused by the weight 
of the uterus and its consequent displacement, dragging down 
the ovaries, straining the broad ligaments, or from sympathetic 
or continuous inflammation of the ovaries. 

Pain in the Sacral or Lumbar Region. — Pain in the 
sacral or lumbar regions, or at the extremity of the coccyx, 
is another very constant symptom of endo-metritis. The pain 
is sometimes at the upper extremity of the sacrum, some- 
times in the locality of its articulation with the coccyx. It 
sometimes causes great discomfort in sitting. There is, in 
some instances, tenderness in these regions, as well as pain, 



222 EATON ON DISEASES OF WOMEN. 

but in other cases great pain is complained of, with no ten- 
derness on pressure. 

We must remember that hemorrhoids, prolapse, or inflam- 
mation of the rectum may produce pains similar to those 
just described. Some writers assert that the rectal difficul- 
ties usually produce more pain on the left side of the sacrum, 
as well as the left natis and hip. I have not taken notice 
of this being so; still, it is well to bear in mind that this 
has been noted by others. 

Pain during Menstruation. — In cases of acute endo- 
metritis we will usually have pain during menstruation; 
at least, at its commencement; while in chronic endo-metritis 
we usually have little severe pain, though the patient com- 
plains of more soreness than usual, and the sympathetic 
pains in the back, loins, and other parts of the body are 
increased. In cases of endo-metritis in women who have 
never born children we very often have severe dysmenor- 
rhoea, owing to the formation of a false membrane, which 
requires strong uterine contractions to discharge, in some 
cases; in others, owing to the narrowing of the internal os 
from the inflammation. 

I think I may safely say there is some degree of endo- 
metritis in most cases of dysmenorrhoea ; so that dysmenor- 
rhcea is one symptom of endo-metritis, especially in those 
who have not been pregnant. These pains are of a crampy 
character, and simulate colic — in fact, are often termed uter- 
ine colic. 

Menorrhagia or Hemorrhage. — Increase of the menstrual 
flow is common in endo-metritis in women who have been 
mothers. It may be that the flow lasts too long, or comes 
on between the regular periods, so as to completely confuse 
the patient in her reckoning as to the regular menstrual 
period. This is particularly the case when the neck of the 
uterus is the seat of most of the inflammation. Sometimes 
partial or complete amenorrhoea results from endo-metritis, 



ENDO -METRITIS. 223 

arising from the general debility induced, as well as the 
induration of the endometrium from chronic inflammation. 

Amenorrhcea sometimes results from chronic endo-metritis, 
I fear, from the nature of the treatment used — I mean the 
use of caustics and strong intra uterine injections. A sort 
of cicatrix of the mucous membrane is produced over a 
whole or a part of the intra-uterine surface, through which 
the menstrual fluid can not pass, and we have amenorrhcea 
as a result. 

Effects on Conception. — While sterility is as likely to re- 
sult from endo-metritis as it is from endo-cervicitis, pregnancy 
will sometimes occur in mild cases of the disease, and, in 
rare instances, progress to full term of gestation. 

During the growth of the foetus, and the consequent 
enlargement of the uterus to contain and nourish it, we will 
have, very often, much complaint of soreness, tenderness, 
and often threatened miscarriage from the irritable condition 
of the uterus, producing a tendency to contract and expel 
its contents ; and very often premature labor results, in spite 
of every precaution we may use. But, in the great majority 
of cases, barrenness is a condition in these cases; but they 
may occasionally become fertile after the endo-metritis is 
cured. 

Generally, after a miscarriage or labor, there is a great 
tendency to acute inflammation; therefore, the physician 
should be particularly careful to have the patient remain in 
bed longer than usual, and see to it that complete involution 
takes place if possible. 

Mental derangements, loss of appetite, indigestion, palpi- 
tation of the heart, headache, gastralgia, heartburn, etc., may 
result from, and be symptomatic of, endo-metritis , as well as 
other uterine diseases ; but as they are not peculiar to any 
special difficulty or disease of the uterus, the totality of the 
symptoms must decide the diagnosis. Differential diagnosis, 
as well -as special, must depend upon the physical examina- 



224 EATON ON DISEASES OE WOMEN. 

tion mostly, in conjunction with the history of the case and 
the general symptoms. 

Etiology. 

The causes which led to the establishment of endo- 
metritis are similar to those producing endo-cervicitis. Cold 
taken at the menstrual period is probably the most frequent 
cause in the unmarried. Masturbation, also, is a cause of 
this disease by producing an excited circulation in the parts, 
by arousing the sexual passion frequently. Sub-involution 
of the uterus, in conjunction with cold, develops the disease. 
An imperfectly detached placenta, abortion, means to pre- 
vent pregnancy, overwork, displacements of the uterus, and 
uterine tumors, all tend to cause endo-metritls. Excessive 
sexual intercourse and fissures of the cervix from lacerations 
may be also mentioned as causing this disease. 

Prognosis. 

The prognosis of enclo-metritis should be guarded. The 
length of time it will take to cure a given case no man can 
tell. One case may progress to recovery rapidly, while 
another will seem so obstinate as to discourage both patient 
and physician. 

Very much depends upon the attention the patient will 
give to the case, and how persistent she will be in the treat- 
ment; and also very much depends upon the possibility of 
preventing the continuous action of any exciting cause of the 
disease. Many times a few weeks of treatment suffices to 
cure very bad cases, while again, it takes several months; 
and in other cases we are doomed to failure. Still, I 
have had a fortunate and happy experience in the cure of 
this disease, which I attribute to having carefully studied 
each case in respect to diagnosing it and its cause, in each 
instance, together with some patience in pursuing treatment. 
The physician who hurries through with his patients either 



END O.-ME TRITIS. 225 

because he is very busy or because he desires to appear so, 
need not expect to be very successful in this disease. 

The engorgement of the vessels of the uterus, in this 
disease, it will take time to remove, and, in case of actual 
hypertrophy of the organ, we must expect to have some 
enlargement remaining, after treatment; though we may get 
rid of the symptoms complained of, a physical examination 
will reveal in some cases that we have still some en- 
largement. 

In the sterile patient we can not positively promise a 
cure, as so much depends on other conditions besides the 
healthy condition of the uterus in securing conception. We 
must remember that granulations in the cervix, vegetations 
of the endometrium, fibroid tumors of the uterus, polypi, 
hydatids, etc., may result from this condition, and the case 
may get worse under treatment, or, rather, in spite of treat- 
ment, in some few cases, which should guard us in prognosis. 

I am of the opinion that the gravity of the disease is 
not appreciated by the people or the profession. Patients 
with this disease are often sadly neglected by the physician 
and friends. A cause of this is doubtless to be found in the 
fact that they are able to go about, and often do so when 
enduring extreme suffering, rather than complain, partly 
from a sense of modesty, and partly from pride (as most 
women prefer that it should not be known that they have 
any disease or weakness of the generative organs). They 
accordingly suffer on, hoping that they will come all right in 
time, or using such domestic remedies as they have heard 
mentioned as useful. Or they call a physician, and enumer- 
ate some of their symptoms, but decline to have a thorough 
examination of their cases made, and they, consequently, 
get poor, very poor treatment. Or they submit to examina- 
tion and treatment by some of those of the Bennett faith, 
who use caustics as heroically as even Dr. By ford could de- 
sire, "having that nerve" which he mentions as necessary 

15 



226 EATON ON DISEASES OF WOMEN. 

to do so "persistently and thoroughly;" and, as they find their 
time, money, and patience exhausted without receiving bene- 
fit, they get very much discouraged. Can we blame them ? 

Cases which have passed through such an experience we 
can safely decline to treat ; or, at least, we will do well to be 
careful to promise little. But with those who have not been 
subjected to the heroic, though mistaken treatment, we may 
expect rapid improvement in the majority of cases, if we use 
proper treatment, and have the patience to study each case 
carefully, and give it the attention it demands ; and we can, 
at the same time, have the co-operation of the patient. 

Very much depends on her co-operation. Most patients, 
with this disease, will call at the physician's office, and very 
much depends upon their attention to the matter sufficiently 
to accomplish a cure. They will often cease treatment when 
the symptoms somewhat subside, concluding that they will 
soon be well any way. Such cases will not generally recover, 
but will soon be as bad as ever, if not worse; and, filled with 
disgust at the failure of finding herself cured, she either neg- 
lects herself till she gets very bad, or consults another doctor, 
or goes off to some water cure, or goes to taking electrical 
baths under the direction of some dishonest traveling mounte- 
bank who advertises largely. 

This, though true, is somewhat of a sad picture in the 
matter of prognosis. These trials we all have, or shall meet, 
and we can not well know in the commencement of the treat- 
ment of any case whether it will give us much trouble or 
not. I do not think these cases have a very great tendency 
to recover when left to themselves. The tendency is to 
increase of the difficulty instead of recovery. 

Treatment. 

In treatment the physician should consider that he has an 
inflammation to treat; not only that, but that the inflamma- 
tion is in an important organ of the body, and that this 



END - ME TRITIS. 227 

organ produces, when diseased, an immense amount of sym- 
pathetic irritation in various other parts of the body. He 
should also bear in mind that the physician's duty is to be 
cautious that in trying to cure he does not harm. 

This feeling has arisen so high in some, that they depend 
entirely upon remedies administered by the stomach to cure 
this disease, as well as all others. Now, while the physician 
should be cautious to do no harm, he is not guiltless who 
leaves undone those things which he should do, and thereby 
allows his patient to suffer, and perhaps die, on account of 
his prejudice against means used by some, because they have 
abused them. We must be brave enough to not be extrem- 
ists, to use judgment in the adaptation of remedial meas- 
ures, and decided and constant in their uses. 

Some practitioners of both schools are in the habit of 
applying Arg. nit. in solid form to the mucous surface of the 
cervix and neck of the uterus, and of introducing into the 
cervix and even to the fundus of the cavity of the uterus 
fuming Nitric acid for the cure of this disease. They may 
speak of the case as one of ulceration all they please. The 
condition is one of inflammation with the exfoliation of the 
mucous membrane, and is, in its entirety, the disease now 
under consideration. 

With this class I can agree no better than with those 
who would use no local treatment; and while I deprecate 
and warn you against caustic treatment, I am in favor 
of and use successfully mild, soothing treatment, as a rule, 
by local application, and in some very chronic cases gentle 
stimulating treatment; still great reliance is to be placed on 
remedies properly selected in conjunction with this treatment 
in chronic cases, and in acute cases remedies may be all that 
are required. 

Treatment of Acute Endo-metritis. 

In case of an acute attack of endo-metritis a warm sitz 
bath, together with a warm foot bath, or the full bath, may be at 



228 EA TON ON DISEASES OF WOMEN. 

once prescribed, following the bath by free, brisk, dry rubbing 
of the entire surface. Place the patient in bed, with plenty 
of cover, and administer Aconite. Give it every half hour or 
hour till a reasonable amount of diaphoresis is induced, then 
only once in three or four hours ; direct the patient to be 
rubbed with a dry cloth every hour or two, to take off from 
the skin the perspiration which is thrown off. After the free 
perspiration is established, if there is much bearing down 
pain, give Bell. If there is alternating heat and cold, hot 
flashes, etc., without the bearing down pain, give Ars. Let 
the patient drink often of moderately cold water; no tea, 
coffee, or opiates. Some homoeopathic physicians seem to 
lose their sense in these acute cases, and give morphia like an 
allopath or an eclectic. It is not necessary. It is not scien- 
tific. It is not good for the patient. Neither can we give 
hypodermic injections of morphia with any more reason. 

While I would prefer to simply state the treatment I 
recommend and practice, I fear silence in this matter might 
lead some young practitioner to the use of objectionable 
methods and means, as too much sanction has been given 
these things in old school books and among some practition- 
ers calling themselves homoeopathic. 

The diet should be gruel or other bland, unstimulat- 
ing food. The recumbent posture should be maintained. 
Following this plan, we will seldom fail, in a few days, to 
entirely cure the case, unless it be one of acute inflammation, 
supervening upon a chronic one, in which case Ave may have 
remaining some chronic inflammation, which will require 
a somewhat different treatment. 

Treatment of Chronic Bndo-metritis. 

The treatment of chronic endo-metritis tests the capacity, 
tact, patience, and perseverance of the physician to the ut- 
most. The patient is usually about the house, and able to 
ride or walk some, but suffers considerable pain in this exer- 



ENDO-METRITIS. 229 

cise. When we get such cases a little relieved they are 
very apt, by want of care or too much exercise, to cause 
a relapse, or they take cold, and a severe inflammation is 
aroused, and the patient feels much discouraged. 

Now, with a full appreciation of the obstacles he may 
expect to encounter the student will be prepared to act 
decisively. He will not feel like promising a cure in two 
or three weeks. It is better not to promise what we are 
doubtful of performing. We thereby lose reputation in the 
estimation of our patients. It is best in the commencement 
of the treatment of these cases to tell the patient it will 
take considerable time to cure her; but assure her that, if 
she has perseverance and patience, and will try to follow 
your directions, she may expect to get well. Explain to 
her that the inflammation has to be subdued and the enlarge- 
ment decreased before she can consider herself well, no 
matter how well she may feel. If it was a chronic enlarge- 
ment of the knee or thyroid gland she would expect that 
it would take time to cure it. Do n't deceive yourself and 
the patient by asserting she is very much better or almost 
Avell about the second or third time you see her. Such en- 
couragement is bound to end in bitter disappointment. 

The first application I would ordinarily make to a case 
of chronic endo-metritis is Bell, ointment, applied to the 
vaginal portion of the neck of the uterus with the finger, 
and. with the uterine applicator, to the internal surface of 
the uterus if there was not great tenderness. If there was 
much tenderness I would only pass a little of the ointment 
into the cervix; or, we may use the medicated suppository, 
made with Bell., afterwards using Hydrastis; or. we may 
sometimes obtain great benefit from the introduction into 
the uterine cavity of rolls of cotton, made in the shape of a 
sponge tent, with a piece of wire to stiffen it, to which is 
attached a string for its removal, having it saturated with 
Glycerine, or Glycerine and Solu. Iodine, or Glycerine and Tr. 



230 EATON ON DISEASES OF WOMEN. 

Hydrastis, allowing them to remain twenty-four hours, and 
then applying a fresh one. Generally it is best to introduce 
into the vagina a ball of cotton to press against this uterine 
tent and prevent its slipping. It is well to have them pre- 
pared of different sizes, and to use as large a one as it is 
possible to introduce, so as to make some pressure upon the 
capillary circulation. 

Much good is accomplished with the ordinary sponge 
tent, moistened partially with Glycerine. In fact, they may 
be, in some instances, more efficient than cotton, but, as they 
are more expensWe, and sometimes dilate the cervix more 
than necessary, and press the fibers of the sponge so firmly 
into the tissues of the uterus as to cause some laceration in 
removing them, I do not recommend them in all cases, but 
only in those where the neck is small, or in cases which are 
very obstinate. 

Sometimes the sea- tangle tent does very well. I would 
place some Belladonna ointment on the end of the tent before 
introducing it, so as to aid dilation, and tend to prevent 
inflammation. In using the sponge tents, I prefer to remove 
them in ten or twelve hours. 

An additional advantage of the tent is that it gives us 
access to the body of the uterus, and it is often for lack of 
getting remedies up to the fundus that we fail. Hence the 
advantage in this direction in using the sponge tent in obsti- 
nate cases, as well as the double advantage I spoke of before 
of compression of the capillaries of the cervix, and the ad- 
vantageous application of the remedies with the uterine ap- 
plicator. (See Fig. No. 68, page 715.) 

In connection with this plan of treatment we may paint 
the neck of the uterus with Solu. Iodine (five grs. Iod. to 
the ounce of water, combined with fifteen grs. Potass, todid.), 
using a camel's-hair pencil, first wiping away all mucous secre- 
tion from the cervix before making the application ; or we 
may apply a wad of cotton saturated with Glycerine and 



END -ME 1 'KIT IS. 231 

Iodine, 1 5 of the former to 1 Z of Solu. lod., made as before 
mentioned. Vaseline should be freely applied to the vagina, 
daily, in these cases, to protect the parts from acrid discharges 
from the uterus, and also to keep the vagina in condition that 
we may use the treatment desired for the uterus. 

The patient should use, daily, vaginal injections of tepid 
water and castile-soap, to cleanse the parts and to wash out 
all secretions. 

At about the menstrual periods all treatment should cease 
till it is over several days. 

Warm, wet compresses, constantly worn over the hypo- 
gastric region, are of much service if care is exercised to 
cover them with dry flannel (using cotton for the compress), 
and binding all tightly with a bandage to hold it on and to 
maintain its warmth ; for if it is allowed to be loose it will 
get cold and be injurious. But, with care in its application, I 
consider the water compress of great value. 

Another means of great value, as I believe, is the abdom- 
inal supporter, to lift the weight of the intestines off from the 
uterus, and keep them from irritating it when in the erect 
posture. If we could keep these patients in bed we would 
have no need of the abdominal supporter; but we can not do 
this ; and to accomplish the holding up of the abdomen with 
proper support calls for ingenuity and patience sometimes. 
The support must be at the lower part of the abdomen. Any 
tightness about the center of the abdomen tends to press 
downwards as much as upwards, and does more harm than 
good. I have recently had Messrs. Wocher & Sons, of Cin- 
cinnati, make for me an improved London supporter (see 
Plate XII), which answers the purpose admirably. With it 
we get the lower elastic strap, lower over the hip, and get 
tightness across the extreme lower portion of the abdomen. 
Leaving the upper strap a little loose, we hold up the abdo- 
men like the hands were applied there, trying to lift up the 
bowels. By this means we often get prompt relief to many 



232 EATON ON DISEASES OF WOMEN. 

of the sympathetic symptoms, and we take from the womb a 
source of irritation. This band should only be worn when in 
the erect posture. When lying down, remove it. The silk 
elastic band or supporter (see Plate XII) does well in case of 
very pendulous abdomens. Without the use of some kind 
of abdominal support we will be greatly hindered in our 
treatment. I would not attempt to cure some of these cases 
without it. • 

Diet. — It is important to have a generous diet given these 
patients — that which is nourishing, but not stimulating. Beef- 
tea, soft-boiled eggs, milk, soup, etc., should be used. Tea, 
coffee, beer, and wine should be avoided, as well as spices and 
all highly seasoned food. As a sensitive stomach and bad 
digestion are some of the sympathetic affections of this dis- 
ease, we need to exercise much prudence in matters of diet, 
as upon the proper nourishment of the body much depends. 
It is of vast importance that food be taken that can be assim- 
ilated. Food difficult of digestion is worse than useless, ex- 
cept in some exceptional cases, where the peculiar idiosyn- 
crasies of the patient may tolerate it. 

Bathing.— Some ladies bathe too much, others not enough. 
Some moderation in bathing is as good as in other things. 
The full bath daily, in Winter, I consider too much, though in 
the heat of Summer, where one perspires very much, it may 
be allowed. The bath should be tepid, not warm. After a 
few moments in the bath the natient should be enveloped in a 
dry sheet, and briskly rubbed by assistants till a full glow of 
the surface is established. Such a, bath in cool weather once 
a week I consider ample. The sitz bath might be taken daily 
in some cases of more than usual severity. 

Attention to the Bowels. — The bowels should not be 
allowed to remain constipated. Use enemae of tepid water 
and soap, and if no evacuation of fecal matter is produced, 
follow r the evacuation of this enema with cold water and soap 
immediately, and we will produce alvine discharges with 



EXDO-METRITIS. 233 

much certainty. Attend to this each morning, with regular- 
ity. The patient should have explicit directions on this point. 
The regular habit is to be encouraged. It is well to 
throw into the bowel a small amount of water, and let it 
remain after the evacuation. Water allowed to remain in the 
rectum tends to allay irritation, and the feverish condition 
usually present in this class of cases. 

Clothing. — Clothing should be worn suspended from the 
shoulders, and be sufficiently loose about the waist to be 
comfortable. It should be sufficient to maintain a healthy 
temperature of the body. The feet and limbs should be kept 
especially warm with warm clothing. Do not neglect to keep 
the feet dry and warm. 

Sexual Congress. — Sexual congress better be entirely 
prohibited. Failure to give these directions often may cause 
the failure of treatment. Where there is any great disposi- 
tion on the part of the patient to indulge in this way reme- 
dies to subdue the passion better be given. This, however, 
will seldom be necessary, as in most cases the act causes 
pain, and is avoided if possible ; but on the partial return of 
health the prohibition may be necessary. I think it well for 
the physician to fully explain the case to the husband at 
first, and thereby obtain some aid from him in carrying out 
proper treatment, as well as sanitary regulations. 

Medicated Vaginal Injections. — In endo-metritis I most 
emphatically say, let them alone. Pure water or soap and 
water to cleanse the vagina is all that is needed in the way 
of a wash. A vaginal douche of warm water may sometimes 
be a comfort and be proper after a walk, or extra fatigue, 
causing some pain. The patient should sit over a chamber, 
and sitting with the bowl of water before her, gently throw 
in the warm water in as steady a stream as possible. It 
will of course pass away at once into the chamber. The 
steady pumping in of warm water for ten or fifteen minutes, 



234 EATON ON DISEASES OE WOMEN. 

sometimes allays the irritation, temporarily, at least, to a 
very great extent. 

Caustics. — I must speak of caustics to enter my protest 
against their use — I hope no student of mine will ever be 
inclined to use them, more than he would venesection. Both 
are recommended in some old-school books. One is as good 
as the other — both are, in my opinion, injurious. Blood- 
letting has gone out of date, but caustics are in their glory. 
Let us hope the end of their use draws nigh. I used them 
over ten years, and I know whereof I speak. Many cases of 
sterility, of partial and complete atresia of the cervix, atrophy 
of the organ, as well as innumerable chronic cases and thou- 
sands of untimely deaths, may be traced to their use, either 
directly or indirectly. 

I am aware I am speaking strongly, but I speak as I feel. 
Those who use them are justified by abundant high authority; 
but, nevertheless, I raise my humble protest. 

Iodine Used with the Hypodermic Syringe. — In chronic 
enlargement of the uterus in these cases it is sometimes 
efficacious to inject into the tissues of the cervix a solu- 
tion of Iodine, from two to five grains to the ounce, by 
means of a syringe ; some like the ordinary hypodermic. (See 
Fig. No. 18, page 171.) 

The speculum is an aid in its use, and the tubes are long 
enough to make its use convenient. Inject at three places at 
one operation ; repeat in five or six days — three operations 
are sufficient in some cases to produce rapid decrease in the 
size of organ. Dr. J. M. Bennett,* of Liverpool, reports many 
cures with this treatment after all other means had failed. 

Remedies. 

Perhaps no remedy is so frequently indicated as Nux. 
Arsenicum, Sepia, Puis., Bell., Br?/., Ars. iodid., Merc, iodid., 

* Dublin Journal of Medical Sciences. 



EN DO -METRITIS. 235 

Ignat., Cubebs, Canthar., China, and Sulph., are of service 
according to their special adaptability in each particular case. 

Those patients of broken down constitution, with weak 
nerves, require Nux, Ars., China. 

If there is a tendency to glandular swellings or eruptions 
of the skin, Rhus, Phytolac. dec, Ars., or Merc, cor., are 
most indicated. 

Where cerebral symptoms are prominent, characterized by 
severe attacks of headache, Jgnatia or Iris vers. 

If the headache is complicated with nausea, Ars., Ipecac, 
or Puis. 

Where the head feels sore like a boil inside, or where we 
have much tendency to stupor, Bell, or Opi. 

If the pain in the head is sharp, darting, lancinating, 
Ac. or Bry. 

For renal complications with mucus in the urine, Can. 
ind., Cal. carb., Canthar., or Cubebs. 

For indurations and enlargement, Merc, iodid., Phytolac, 
Bell. 

For leucorrhcea, Puis., Sepia, Sulph., China. 

For palpitation, Dig., Ignat., Verat. viride. 

Secale, Nux, or Ars., in case of debility with diarrhoea, and 
a tendency to anasarca. 

We should look out for displacements in these cases. Not 
only the partial prolapse, but retro-flexion or ante-flexion 
especially. I take it for granted that no practitioner would 
overlook a case of retro-version or ante-version, as they are 
readily recognized ; but some cases of flexions are rather 
hard to detect; in fact, I may say, impossible, except with the 
aid of the uterine sound. 

We will not meet with much success in the treatment of 
any form of inflammation of the uterus or appendages if 
flexions exist, unless we first rectify the flexion ; hence, it is 
well to lose no time in determining whether or not there is a 
flexion in the case. 



236 EATON ON DISEASES OF WOMEN. 

A failure to do this is a very frequent cause of the want 
of success in the treatment of these cases. I feel positive I 
might relate numerous cases in illustration which have readily 
yielded to treatment after the flexion was rectified, which 
had been under good treatment otherwise for years by emi- 
nent physicians who had overlooked the flexion. 

Pessaries. — Pessaries must be avoided in these cases, if 
possible, though I would use them if I failed to rectify the 
flexion or version without them. It is very seldom of late 
years that I have any occasion to use a pessary in any case ; 
and I especially avoid them in any inflammation of the uterus. 
The taking off of the weight of the bowels by means of a 
suitable abdominal supporter, as before mentioned, and occa- 
sionally introducing a medicated ball of cotton into the 
vagina, after I have placed the womb in situ, I almost always 
find sufficient to obtain a permanent relief from the flexion 
or version. 

It is astonishing, in some instances, how quickly the 
inflammation subsides and the discharge ceases when the 
version or flexion is rectified. I will relate a case or two in 
exemplification, though, if time permitted, I might relate 
cases for days somewhat similar. 

In October, 1877, Mrs. B., aged about thirty-three years, 
came to me from one hundred and thirty miles in the interior 
of the State. Native of Ohio; married twelve years; about 
nine years since was delivered of a seven-months still-born 
child ; no pregnancy since. For most of the time since her 
confinement, she has had a leucorrhceal discharge, which for 
three or four }'ears has been extremely bad smelling. Great 
tenderness and soreness had been suffered for seven or eight 
years, so much so as to make it almost impossible to endure 
copulation ; bowels constipated, some cough, general emacia- 
tion, no appetite, bad digestion, some nausea, catamenia very 
profuse and painful, lasting about ten days, and returning in 
ten or twelve days. Life was almost a burden to her ; she 



END O -ME TRITIS. 237 

could not perform any labor, and suffered extreme backache 
and headache. 

She had been treated by five or six different physicians 
of good ability with no relief, they having finally diagnosed 
the CMse to be cancerous. On attempting to make an exam- 
ination I found the vagina so tender I desisted, and applied 
Bell, ointment to it three times a day for two days, when I 
found I could proceed to make an examination of the uterus 
without causing much pain. On introducing the finger I 
found the os in its normal position, except somewhat lower 
in the pelvis than is natural, hard, and enlarged to three 
times the normal size. The sound revealed a retro-flexion, and 
showed the uterus to measure four inches in length. I ap- 
plied my abdominal supporter (see Plate XII), and con- 
tinued the Bell, ointment in vagina, and prescribed Nnx 3 X 
every three hours. On the third day following I replaced the 
uterus with Elliott's uterine elevator (see Plate XIV), patient 
on knees, with hips elevated more than the shoulders. Let 
her lie upon her side twenty-four hours, and allowed her to 
get up and go about, still wearing the abdominal supporter 
when up. Applied Solu. iodine with brush and applicator to 
the cervix uteri twice a week, and continued Bell, ointment 
and prescription of Nux 3 X , directed the vagina to be cleansed 
with soap and tepid water, morning and evening, with good 
nourishing diet. 

Within four weeks all the discharge had ceased; very 
slight tenderness remained in the fundus, none in the vagina 
or neck of the uterus; copulation not painful; flesh increasing 
rapidly; only very slight pain in back or head; menstruation 
less profuse, and lasted but five days. Continued treatment 
to reduce size of uterus for two months longer, and dis- 
charged the case, she says, in perfect health. Eight months 
later reported still well. 

Case Second. — Mrs. L., of Cincinnati, native of New 
York, aged thirty-seven years, of slight build, light com- 



238 EATON ON DISEASES OF WOMEN. 

plexion, nervous temperament, consulted me, July 6, 1878. 
Found retro-flexion of uterus, with endo-metritis. She com- 
plained of partial loss of eyesight in both eyes. (She had 
consulted Prof. Wilson, a celebrated oculist of this city, now 
of Ann Arbor, Michigan, who had diagnosed the cause of her 
trouble to be reflex nerve irritation from uterine disease, and 
had sent her to me for treatment.) She stated that the eyes 
had been troubling her for over three years, being unable to 
read or sew. The eye looked well, except weak, with a sort 
of stare. 

Her history was a sad one of having been treated almost 
constantly for twelve years, during three of which she had 
had the constant care of Prof. Sims, of New York City, whom 
she considered the most eminent gynaecologist in America. 
He had used tents, scarification, etc.; others had used caustics 
ad infinitum. Still she got no better. Her menstruation had 
never been free, pain in her back and head was constant, dys- 
pepsia her constant trouble. She had tried hygienic and 
water-cure treatment, was troubled much with leucorrhoea and 
constipation, great aversion to sexual connection, which was 
very painful, her husband informed me. 

I commenced the treatment of this case with much dis- 
trust of my ability to relieve her. Her long illness, inca- 
pacitating her for any exercise without severe pain, taken in 
connection with the eminent skill she had employed, was 
certainly unpromising; but I concluded to make an attempt. 
I at once applied my abdominal supporter (London), and 
replaced the retroflexed uterus, gave Sepia, Nux, and China 
singly, a few days each, then only Can, ind. till she was well 
(six months from commencement of treatment). 

I never had to replace the uterus again. It remained all 
right. The leucorrhoea ceased, the tenderness left, her diges- 
tion became good, her bowels regular, her menses more pro- 
fuse, lasting three days; her eyesight became stronger, so 
that in November she worked a beautiful pair of slippers, and 



END. -METRITIS. 239 

gave me, besides paying me a good fee in cash. Now, about 
two years since I commenced treatment, she is still well, 
reads, sews, and walks as far as any lady. I have not treated 
her any for about eighteen months. She is rosy-looking and 
gaining flesh ; her menstruation comes with regularity and 
quite freely. She has sent me many patients the past six 
months, including two from New York City, who have just 
arrived (old friends of hers in New York). 

I relate these cases from my note-book informally, to im- 
press the student with the importance of correct diagnosis as 
to the cause of the disease as well as its nomenclature. It is 
much better to make a mistake in naming a disease than in 
discovering its pathology and etiology. These ladies, who are 
now in health, might doubtless have been more easily restored 
years before, and saved years of suffering, had their ailment 
been correctly diagnosed. In both cases their sympathetic 
symptoms had been mistaken for the real disease by several 
physicians. 



240 EATON ON DISEASES OF WOMEN. 



CHAPTER XXI. 

LEUCORRHCEA — WHITES. 

This term signifies an unnatural discharge other than 
blood from the female genital organs. It is not a disease in 
itself, but really a symptom only of inflammatory action in 
the vagina, or uterus. In the healthy woman there is a 
mucous secretion in the vagina, for the lubrication of the 
parts, which is oily in its nature ; but in disease we have 
various discharges, differing in appearance and consistency, 
which are termed leucorrhoeal. Patients complain of a 
leucorrhceal discharge, and the physician may often prescribe 
for it, without explanation of its true nature. 

The term " whites " is sometimes used to designate this 
complaint. It may affect girls or women of any age ; even 
infants are sometimes affected with it. It is sometimes easily 
cured, and again it is A r ery obstinate, owing to the various 
causes upon which it is dependent. 

The discharge may be thin or thick, and white or yellow. 
The yellow discharge indicates the uterine origin of the dif- 
ficulty. The white and watery discharge comes from the 
vaginal mucous membrane. It may be catarrhal in its nature, 
and affect at once the lining membrane of the vagina, cervix 
and endometrium simultaneously, in which case we have a 
varied appearance of the discharge, sometimes thick, some- 
times thin, again some yellow matter mixed with the thin 
white discharge, and so on. 

Diagnosis. 

It is not difficult to diagnose that we have or have not 
leucorrhcea, but it is not always so easy to make out its 



L E I r COR ii IKEA — WH1 TES. 24 1 

cause. It is true, it must be from the irritation in the vagina 
or uterus ; but the cause of this irritation is the thing to 
find out. 

Ordinarily we will take the patient's description of the 
discharge and her symptoms to guide us in the selection of 
remedies ; but in case we are not soon successful in curing 
it. we will do well to investigate carefully for ourselves as 
to the cause of the ailment. These causes need not be 
enumerated here, as the student may turn to the chapters 
on endo-eervicitis, enclo-metritis, vaginitis, and metritis, and 
read the causes there enumerated. Hence diagnosis and eti- 
ology go hand in hand in this difficulty. The patient says 
she has whites or leucorrhoea. Your next thought should 
be, What causes it? 

The success in treatment will largely be dependent upon 
close discrimination as to its nature and etiology. It must 
be borne in mind that the inflammation may be chronic, or 
sub-acute. It may be so mild as to be scarcely recognized 
as an inflammation at all — being confined mostly to the glan- 
dular structure of the vagina, which may pour out an abundant 
discharge, though there may be no tenderness or heat observ- 
able in the parts. In these cases the vagina will be found 
loose and flabby. 

The yellow leucorrhoea indicates exfoliation of the epith- 
elial layer of mucous membrane, from some preceding active 
inflammation, and that pus is being secreted on this denuded 
surface; and this condition may be expected to be found 
either upon the cervix or in the interior of the uterus. The 
white albuminous discharge from the os is simply an excess 
of natural secretion in the uterus, showing some undue con- 
gestion of the endometrium, but may pass away without 
treatment in a very short time. The discharge of a large 
amount of pus at one gush, of course, will indicate the for- 
mation and rupture of an abscess. 

16 



242 EATON ON DISEASES OE WOMEN 



Treatment. 



Some recent catarrhal cases will be speedily cured with 
Aconite, followed in three or four days with Sepia ; and if this 
is not sufficient give Cal. carb., frequently bathe the parts 
with castile-soap and water. Hip-baths are also of service. 
As the discharge tends to debility, a. good nourishing diet is 
necessary. If the patient is very much prostrated from 
chronic leucoi rhoea, China, Ars., Merc., Nux, or Puis, may be 
indicated. After the vagina and labia are well cleansed, it is 
well to smear the parts with Vaseline, and, in case of children 
and infants, place a soft cotton cloth, smeared with Vaseline, 
between the labia, to prevent adhesions, and, in some in- 
stances, it is well to gently press a small bit of the cloth, so 
oiled, up into the vagina, to prevent occlusion. 

Astringent washes are not needed. Sometimes the local 
application of a little Glycerine and Hydrastis is, however, 
beneficial. In the form I mentioned as being characterized 
by the relaxed, flabby condition of the vagina, the stimulating 
effect of dilute Citrine ointment, applied to the vagina once a 
day, may aid us in making a rapid cure. Try to remove the 
exciting cause of the difficulty. Never rest satisfied without 
doing this, if you can ascertain what it is. 

There is in some cases of suppression of the catamenia a 
leucorrhceal discharge which seems to take the place of the 
regular menses, lasting about as long, or a little longer, than 
the menses usually did. This form of discharge is not really 
leucorrhceal, but a conservator of health. It is really a per- 
verted or incomplete menstruation, and calls for Puis., Macro- 
tis, Cocculus, etc., not to suppress it, but to cause the more 
free flow, which would probably be healthy menstrual fluid. 
So we are constantly reminded of the need of taking into 
account the whole of any given case, and not let one symptom 
obscure our vision in regard to others, or the conditions pro- 
ducing them. 



LE UCORRHCEA — WHITES. 243 

Remedies in t,eucorrhoea, -with Special Indications for their use. 

In addition to Aconite ', Sepia , Col. curb., China, Ars., Merc, 
Nux, Puis., etc., which I have named, the following remedies 
are of service in some cases of leucorrhcea, given when indi- 
cated by the totality of the symptoms, which should be care- 
fully studied in works on therapeutics. The leucorrhcea may 
be kept up by reason of diseases somewhat remote from the 
vngina, and, consequently, there may be indications for reme- 
dies ordinarily only demanded in other diseases. These rem- 
edies are Bovista, Graphites, Kreosotum, Conium, Muriat. acid. 
Nit. ac, Platina, Macrotin, Podophyllum, Lye, Sulph., Carlo 
veg., Phos., Zinc, Canthar., Bryonia, Sabina, Sil, Senega, St ami., 
Ferrum, Can. ind., Thuja, Hepar, etc. 

Dr. Leadam* gives, in Acute Leucorrhcea, Aeon., Amm. c, 
Borax, Cal. c, Carb. v., Con., Kali c, Phos., Puis., Plat., Sab., 
Sep., Sidph. ac. 

In Chronic Leucorrhcea. — Alum, Amm. c, Ars., Carb. a., 
Carb. v., Caust., Canth., China, Cham., Con., Ign., Kali c. 
Kreos., Lach., Lye, Merc, Mez., Mag. c, Nat. m., Nit. ac, 
Phos., Pids., Ruta, Sil, Sidph., Sulph. ac, Stan., Zinc 

When the Discharge is Fetid. — China, Kreos., Nat. m., 
Nit. ac, Nux v., Sabina, Sep. 

For Yellow Leucorrhcea. — Aconite, Alum., Ars., Boo.. 
Carb. an., Carb. v., Cham., Kali, Kreos., Lac, Natr. m., Nux 
v., Phos. ac, Sabina, Sep., Sidph. 

For Brown Leucorrhcea. — Ammon. mur., Nit. ac 

For Green Leucorrhcea. — Bov., Carb. v., Merc, Fids., Sep. 

For Watery Leucorrhcea. — Amm., Ant. cru., Ant. tart., 
Carb. an., Carb. v., Cham., Chin., Graph., Ifreos., Mag., Merc. 
Mez., Nitr. ac, Puis., Sep., Sil, Sulph. 

For Thick Leucorrhcea. — Ambr., Ars., Carb. veg., Magn. 
m., Natr. m., Puis., Sabina, Sepia, Zinc. 

For Milky Leucorrhcea. — Amm?, Calc, Carb. veg., Can., 

* " Diseases of Women," pp. 46, 47. 



244 EA TON ON DISEASES OF WOMEN. 

Ferrum, Graph., Kreos., Lye, Nat. mur., Phos., Puis., Sabina, 
Sep., Sil., Sulph., Sulph. ac. 

For Bloody Leucorrhcea. — Alum., Ars., Canth., Garb, veg., 
Ghina, Cocc, Con., Lye, Sep., Sil., Sulph. ac. 

For Mucous Leucorrhcea. — Alum., Ambr., Amm. m., Ars., 
Bell., Bor., Bov., Bry., Gale, Canth., Garb, an., Garb, v., Gocc, 
Con., Ferr., Graph., Guiac., Kreos., Magn., Merc, Mezer., Nalr. 
m., Nitr., Nitr. ac., N vom., Petr., Phos., Plumb., Puis., Sabina, 
Sass., Seneg., Sep., Stann., Sulph., Sulph. ac, Thuja, Zinc. 

For Leucorrhgea with Burning. — Amm., Ars., Bor., Calc, 
Ganlh., Garb, an., Gon., Kali, Kreos., Puis., Sulph. ac. 

For Leucorrhcea with Itching. — Alum., Anac. Ars., Gale, 
Chin., Ferr., Kali, Kreos., Merc, Phos. ac, Sabina, Sep. 

For Corrosive Leucorrhcea. — Alum., Amm., Ant. c, Ars., 
Bov., Gale, Cann., Canth., Garb, an., Garb, v., Cham., China, 
Con., Ferr. Hep., Lgn., lod., Kali, Kreos., Lye, Magn., Magn. 
m., Merc, Mez., Natr. m., Nitr. ac, Phosph., Ph. ae,Puls., 
Ranun. bulb., Rut a, Sep., Sil., Sulph., Sulph. ac, Thuja. 

Aconite is indicated when leucorrhcea is complicated with 
great timidity, especially after a fright; fear of approaching 
death ; inconsolable anxiety ; predicts the day of death ; 
excessive restlessness ; vertigo, with nausea and vanishing of 
sight; burning headache, as if the brain were agitated by 
boiling water; scalp sensitive to the touch. 

Ars. Alb. — "The leading feature of this remedy is the 
nervous restlessness, with rapid emaciation and thirst;" is 
sad and tearful ; head confused, dizzy, stupefied ; face has a 
cachectic look; sunken; covered with cold sweat; is expres- 
sive of great mental agony; drinks often, but little at a time; 
loathing of food ; leucorrhcea profuse, yellow, thick, corroding 

Cal. Carl). — Rush of blood to the head ; leucorrhoea like 
milk ; ravenous hunger or complete loss of appetite ; feet feel 
cold and damp ; great weariness ; not able to walk ; profuse 
sweat on slightest exertion; sweating of the palms of the 
hands. 



LE UCORRHCEA — WHITES. 245 

China. — The key-note symptoms of this remedy are pros- 
tration, with neither thirst nor hunger ; ringing in the ears ; 
taste flat, insipid, slimy, and bitter; leucorrhoea, instead of or 
before menses, with spasmodic uterine contractions, is very 
sensitive to pain and to draughts of air. 

Mercurius. — The chief characteristics of this remedy are 
an aggravation of all the symptoms at night, and from the 
warmth of the bed ; weakness of memory ; answers ques- 
tions slowly; intolerance of sunlight; aphthae in the mouth; 
painful dryness of the throat, with mouth full of saliva; ex- 
tremely violent thirst; leucorrhoea greenish, with smarting, 
itching, burning after scratching. 

Nux Vom, — Can not think correctly ; stupefaction ; ver- 
tigo after dinner ; taste sour ; vomiting of sour mucus ; hun- 
ger, with aversion to food, especially bread ; constipation, with 
frequent and ineffectual desire for stool and sensation of con- 
striction in rectum. 

Pulsatilla. — Mild, gentle, timid, yielding disposition, with 
inclination to weep; out of sorts with every thing ; fretful; ver- 
tigo, must lie down; paleness of the face; accumulation of 
sweet saliva in the mouth; absence of thirst; leucorrhoea 
thick like cream, with swollen vulva; dry cough at night; 
shortness of breath ; anxiety and palpitation when lying on 
the left side. 

Sepia. — Great apathy ; indifference to every thing, even 
to one's own family ; indolent mood ; face pale ; yellow leu- 
corrhoea, excoriating, like pus. 

Bovista. — Leucorrhoea, after menstruation, while walking, 
thick, slimy, tenacious, like Avhite of egg ; with drowsiness ; 
with anxious dreams ; ill-humored. 

Graphites. — Leucorrhoea comes in gushes, is very pro- 
fuse, and sometimes excoriating; appears day or night; taste 
like rotten eggs in the morning ; painful, sore nipples. 

Bryonia. — The symptoms are worse towards night, 
after waking, after a meal, from motion and contact ; 



246 EATON ON DISEASES OF WOMEN. 

better during rest; with anxiet}', discouragement; with leu- 
corrhoea. 

Coiiium. — Violent leucorrhoea, with hoarseness, cough, 
and expectoration ; weakness and pain in small of back, with 
labor-like pains from both sides of abdomen ; symptoms worse 
during rest. 

CantharicleSc — Violent itching in the vagina; pressing 
towards the genital organs; pale face, with wretched, sickly 
appearance ; stinging over the whole body ; painful mictu- 
rition. 

Cannabis Ind. — Leucorrhoea, complicated with frequent 
micturition; mucus in urine when cool; threatened abortion; 
dizziness of vision; excessive sexual passion, etc. 

Carbo Veg. — Leucorrhoea., with great weakness ; flatus in 
the abdomen; slimy diarrhoea, with hemorrhoids; itching of 
the vulva. 

Macrotin. — Leucorrhoea, with neuralgic or rheumatic 
dysmenorrhoea ; insomnia, with nausea; pain in the eye-ball 
and top of head, pressing upwards and outwards. 

Ferrum. — Leucorrhoea, with monorrhagia; flushed face; 
anaemia, with pale face; palpitation, etc.; vomiting at mid- 
night ; great weakness ; leucorrhoea corrodes the parts ; itch- 
ing in the vulva. 

Hepar Sulph. — Leucorrhoea in scrofulous patients ; fall- 
ing out of the hair; useful after the abuse of Mercury. 

Lycopodium Clavatum. — Leucorrhoea, with constipa- 
tion ; red sand in the urine ; terrific pain in the back ; pains 
in the pelvis from the right to the left side, worse at four 
P. M. ; sharp pains in the labia; one foot cold, the other hot; 
sallow color of the skin. 

Kreosotum. — Leucorrhoea, putrid, acrid, or corrosive in 
character; very offensive odor; cancer of uterus; burning in 
the vagina; menses too profuse; deafness during menstrua- 
tion ; oedema of the feet, with constipation. 

Mnriat. Ac. — Leucorrhoea, with uterine ulceration ; great 



LEUCORRHCEA — WHITES. 247 

weakness ; dryness of the mouth ; watery diarrhoea, with 
hemorrhoids. 

Nitric Acid. — Leucorrhoea, with secondary syphilitic 
affections ; applicable to cases where too much Mercxmj has 
been used ; torpid action of the liver ; cases complicated with 
prolapsus ani, with smarting, burning pain in the rectum ; 
urine has a very offensive odor ; especially adapted to patients 
with dark complexion, black hair and eyes. 

Phosphorus. — Leucorrboea in patients with fair skin, 
sanguine temperament ; sensation of weakness in the abdo- 
men ; profuse menstruation ; leucorrhcea is acrid. 

Platina. — Leucorrhcea, with uterine hemorrhage ; bearing- 
down pain in pelvis ; leucorrhcea occurs only in the daytime ; 
induration of the cervix uteri ; burning pain in the ovaries ; 
hysterical symptoms, or spasms; feeling of numbness over 
the whole body ; palpitation of heart, etc. 

Podophyllum. — Leucorrhcea, with nausea and giddiness ; 
bitter taste in the mouth ; dark urine. 

Sabina. — Leucorrhcea, with profuse painful menstruation ; 
strangury; the leucorrhcea is thin, and has an offensive odor; 
tendency to abort about the third month ; bloody urine ; irri- 
table temper, etc. 

Silicea. — Leucorrhoea, with constipation ; colorless men- 
strual flow, complicated with induration of the lymphatic 
glands in any part of the body ; has bad dreams ; adapted to 
scrofulous constitutions; dizziness, with disposition to fall 
forwards. 

Stannum. — Leucorrhoea, with great weakness of the 
limbs ; insatiable hunger ; great weakness is the key-note 
symptom of this remedy. 

Senega. — Leucorrhcea, complicated with chronic bron- 
chitis. 

Sulphur. — Leucorrhoea, with voluptuous itching; the 
discharge is offensive and corrosive. 

Thuja. — Leucorrhoea, with syphilitic contamination ; con- 



248 EATON ON DISEASES OF WOMEN. 

dylomata on the genital organs; burning in the urethra; 
headache on left side; can not sleep at night; burning pain 
in left ovary. 

Verat. Alb. — Leucorrhoea, with violent, copious diarrhoea, 
nausea, etc. 

Verat. Vir. — Leucorrhoea, with congestive conditions; 
pupils dilated ; mouth and lips dry ; cases complicated with 
pneumonitis. 

Zinc. — Leucorrhoea, with excessive sexual desire ; pain in 
left ovary ; patient walks in her sleep ; constipation, etc. 



BARRENNESS AND STERILITY. 249 



CHAPTER XXII. 

BARRENNESS AND STERILITY. 

The term "barren" should be applied to those cases 
which are unfruitful (do not bear children) on account of 
some abnormal and incurable development of the female gen- 
erative organs, or through the action of disease that is present, 
causing a condition which makes it impossible for conception 
ever to take place; while the term "sterile" should be ap- 
plied to those cases which are unfruitful on account of some 
functional derangement of normally developed organs, or on 
account of some deformity or displacement which can be 
remedied, or on account of some want of sexual affinity with 
the husband. 

These distinctions are, however, not usually made by the 
profession, and the terms " barren " and " sterile " are commonly 
used as synonymous. I think it wise, however, to make a 
distinction in the terms, for the reason that, when used in a 
limited sense, either term conveys to the mind the condi- 
tion present, to some extent, as understood by the writer 
or speaker. When using the term "barren" he would 
convey the idea that the patient was hopelessly unfruitful, 
while if he used the term "sterile" he would indicate that 
although childless, he considered the patient physically 
capable of bearing children, after being subjected to proper 
treatment. 

It is often of vast importance that sterility should be 
cured, so that barrenness does not result. This is the case 
in families where property is entailed, as well as for the hap- 
piness of those who desire offspring. 

The physician is often consulted regarding patients who 



250 EATON ON DISEASES OF WOMEN. 

have thus far been childless, or have become sterile after 
having conceived once or twice. It becomes us, therefore, to 
give no hasty opinion, or treat the case as of little moment, for 
the possibility or impossibility of being able to bear children 
may be, to our patient, of the greatest importance. 

Before pronouncing a patient barren, it is our duty to 
thoroughly investigate the case, and ascertain if there be any 
functional derangement, or abnormal development, which we 
might be able to rectify by remedies or operation. In order 
to be able to make a correct diagnosis, the physiology, as 
well as the anatomy, of the female genitalia must be well 
understood. The process of healthy ovulation — the normal 
condition of the fallopian tubes, uterus, and vagina — must be 
comprehended, and the influence of the mind and nervous 
system upon copulation and conception must be noted, or we 
may fail to correctly diagnose and treat the case, thereby 
leaving the patient hopelessly barren, who might be only 
sterile had we properly understood the case and used proper 
treatment. 

The student should thoroughly study the female organs of 
generation in the dissecting room, as well as from works on 
anatomy and physiology. Greater facility of diagnosis must 
come from the frequent examination of women in active 
practice. 

I do not deem it necessary here to enter into detail 
regarding the anatomy and physiology of the ovaries, uterus, 
and vagina. They may be learned from the means and 
books referred to. (It is to be understood that we are pre- 
suming that the patient is married, and that healthy sperma- 
tozoa in healthy semen is properly deposited in the vagina by 
the male.) 

Sterility or barrenness may be congenital, or acquired. 
A woman may bear a child, and from the development of 
disease subsequently may become sterile, or even hopelessly 
barren. 



BARRENNESS AND STERILITY. 251 

Ktiology. 

First, the causes which produce barrenness are absence of 
or incurable abnormal development of the ovaries, fallopian 
tubes, uterus or vagina; false membrane covering the ovaries, as 
a result of cellulitis, ovaritis, or peritonitis ; the presence of 
double ovarian tumors, very large intra-mural fibroids of the 
uterus, and cancerous or tubercular disease of the ovaries or 
uterus. These conditions must necessarily entail barrenness 
or hopeless and incurable unfruitfulness. When the patient 
is found suffering from either of these conditions or ailments, 
we can decide the case barren. She may prove to be barren 
when at first she presents only the symptoms indicating ster- 
ility. If she prove incurable of those ailments ordinarily 
producing sterility she then, of course, is "barren." 

Sterility may result from atresia of the vagina or cervix 
uteri, imperforate hymen, flexions of the uterus, extreme ver- 
sions (posterior, anterior, or lateral), elongation of the cervix 
uteri, endo-cervicitis, endo-metritis, inversion of the uterus or 
complete procidentia, vaginitis, vaginismus, excessive alka- 
linity of the uterine secretions, excessive acidity of the 
vaginal mucus, uterine hemorrhage or polypi, imperfect nutri- 
tion of the uterine organs, causing atrophy or arrest of func- 
tion. This latter condition is most frequently found in those 
who have married late in life, or have exhausted their nerve 
strength by hard and excessive study or labor, with want of 
proper physical exercise and suitable food. The laceration 
of the perineum in labor, or from other accidents, may render 
the women sterile or barren, even if there is a failure to 
restore it by operation. Incompatibility between husband 
and wife may be a cause of sterility, but not of barrenness, 
for the impossibility of impregnation would disappear if the 
patient should marry to a congenial companion. 

It is self-evident that the causes which I have enumer- 
ated as producing barrenness are incurable, and hence the 



252 EATON ON DISEASES OF WOMEN. 

woman so affected is permanently unfruitful, and may be 
termed "barren." 

Regarding those causes which produce sterility, I may 
remark, somewhat in detail, that so far as possible the stu- 
dent may comprehend why it is that these causes produce 
sterility. It is evident that in the case of imperforate hy- 
men, atresia of the vagina, or uterus, the semen can not be 
introduced into the cavity of the uterus; consequently, no 
impregnation can result, unless by surgical interference these 
deformities are remedied, after which impregnation and ges- 
tation may go on normally. 

Flexions of the uterus are often the cause of sterility by 
narrowing the canal of the cervix at the point of greatest 
flexure ; besides, in the patient affected with flexion of the 
uterus the retention of the menstrual secretion caused by the 
flexion produces a diseased condition of the lining membrane 
of the uterus, and may affect it to the extent of making 
conception impossible, even after the flexion has. been cured. 
The abrupt flexure of the organ, either in its cervical portion 
or at the juncture of the cervix and body, is almost certain 
to cause sterility, while the moderate curvature of the organ 
may not do so. 

The proportion of married women who have flexions and 
are sterile, according to Emmett,* is 54.76 per cent; the un- 
married were 25.80 per cent — making a total of 80.56 per 
cent of all women afflicted with flexures in any part of the 
uterus, who were either unmarried or sterile, leaving only 
19.44 per cent who were fruitful at all. He does not say 
whether any became fruitful after the flexure was treated, 
or whether the flexure had taken place after gestation. 
These statistics he gives from three hundred and forty-five 
cases coming under observation. This, I think, accords with 
my own experience, and, so far as I can learn from books and 
otherwise, is about the experience of others. 

* Emmet's " Prin. and Prac. of Gynaecology." 



BARRENNESS AND STERILITY. 253 

Of the whole number of fruitful women who hud flexions 
10.44 had flexions of the cervix, and 89.56 per cent of the 
body of the uterus ; forty-three of the three hundred and 
forty-five cases were lateral flexions, out of which number 
twelve were fruitful (six were unmarried.) Of married 
women affected with flexions of the cervix 94.16 were sterile. 
Dr. Emmet thinks that in the very few instances where this 
class of women were supposed to have become impregnated, 
that there was a mistake in diagnosis, and that future obser- 
vations will demonstrate that flexions of the cervix are a 
sure prevention to conception, and are to be accepted as 
proof that impregnation had never taken place. (He does 
not, however, claim that conception is impossible after the 
flexion is cured.) \ 

The conclusion to which we must come, from all sources 
of information, is, that all forms of flexion of the uterus are 
liable to cause sterility, that flexions in the body of the uterus 
cause sterility much less frequently than flexions of the cervix. 

Versions of the uterus tend to cause sterility by causing 
the os uteri to ascend and lie transversely in the pelvis, and, 
consequently, the os is obstructed by the vaginal membrane 
on the side to which it is inclined. 

About 57 per cent of those women who have ante-version 
and about 87 per cent of those with retro-version are sterile. 
Lateral versions, not usually being so complete as retro-version, 
cause sterility in only 50 per cent of those affected with the 
displacement. 

Elongation of the cervix causes sterility, by making it 
difficult for the spermatozoa to enter the os, on account of 
the distance it projects into the vagina, and the depth of the 
vaginal cul-de-sac around it. The per cent of those sterile 
who have this deformity is not less than 90. 

Endo-cervicitis and endo-metritis cause sterility in several 
ways : First, by the irritable condition they induce, prevent- 
ing the entrance of the spermatozoa or the attachment of the 



254 EATON ON DISEASES OF WOMEN . 

impregnated ovum. They also may cause sterility from the 
hemorrhage they produce and the unhealthy secretions they 
develop. 

Vaginitis may cause sterility, from the intense acidity of 
the vaginal secretions and the tendency which there is in 
these cases to expel the semen suddenly from the vagina 
before it can enter the os uteri. Vaginitis also causes dyspa- 
reunia, which prevents the development of the sexual orgasm 
so favorable to conception. 

Vaginismus causes sterility, by either preventing copula- 
tion in toto or stopping the sexual orgasm. 

Excessive alkalinity of the uterine secretions, or excessive 
acidity of the vaginal mucus, may destroy the vitality of 
the spermatozoa, and hence cause sterility. 

Uterine hemorrhage, from whatever cause, is likely to cause 
sterility, by preventing the entrance of the spermatozoa into 
the uterus, or washing it away, if it gain admittance. 

Uterine polypi, or hydatids, vegetations of the endometrium, 
etc., cause sterility, by blocking up the cavity of the uterine 
canal, and by causing hemorrhage, which, as well as unhealthy 
secretions, prevent the fructification of the ovum." 

Deficient nutrition of the ovaries may cause a failure of 
maturity of the ovum, and hence cause sterility. 

That incompatibility between the wife and the husband 
may cause sterility is probable by instances which I have 
observed, and heard of, where parties have not had children, 
and where both parties became parents after being divorced 
and married to other companions. This proof is, however, 
not positive, as the lady may have been suffering from some 
disease while married to the first man, and might have become 
henlthy afterwards ; or she might have used preventive meas- 
ures with the first, and not Avith the second husband ; or the 
husband might have been at fault by reason of disease, of 
which he might have become afterwards cured. The proof is 
presumptive, however, as it is probable that, in those cases 



■ BARRENNESS AND STERILITY. 255 

where there is an a version to each other, there will be little 
sexual passion felt or manifested, and there is, consequently, 
a great tendency to unfruitfulness. 

The atony and atrophy in those educated and refined 
ladies who marry late in life prove a cause of sterility, not 
only from loss of sexual passion, but from loss of nutrition 
of the parts. There are, however, exceptions in this class of 
women ; but it is usual that, with women of large mental 
development, the physical strength declines, not only sex- 
ually, but otherwise as well, especially when they live a life 
of celibacy till thirty years of age. This, at least, is my 
observation. 

Excessive venery is also a cause of sterility, by inducing 
inflammation of the ovaries, uterus, and vagina. Some sterile 
women are excessively passionate, and it is sometimes pre- 
sumable that excessive amativeness may be a cause of sterility; 
or it is possible that the irritation of the ovaries causes the 
excessive passion and the sterility, so that they both have 
similar causes, instead of the one being produced by the 
other. Hemorrhage from the bowels, hemorrhoids, and rectal 
fissure may be indirect causes of sterility. 

Diagnosis. 

The diagnosis in cases of those who are unfruitful is for 
the purpose of determining the cause of the failure of impreg- 
nation. The fact of unfruitfulness is patent to every one. 

The diagnosis of the cause which produces the unfruitful- 
ness is of importance to determine whether or not measures 
and remedies are advisable, or whether the case is hopelessly 
barren. Upon the correct diagnosis of the cause of the 
sterility much depends. 

The diagnosis of flexions and versions of the uterus, vag- 
inismus^ vaginitis, endo-metritis, endo- cervicitis, uterine hemor- 
rhage, polypi, etc., may be read under their proper heads. 
The unhealthy secretions are usually caused from inflamma- 



256 EATON ON DISEASES OF WOMEN, 

tion in some part ; but they may serve as an index to the 
treatment required. Ordinary test paper may be used to 
determine the excessive acidity of the vaginal secretions, 
which will be indicated by the turning of the blue paper to a 
blight red when placed in the vagina. If only a slight pink- 
ish tint is given to the blue paper, it is indicative of a normal 
condition. The uterine secretion may be received upon the 
lower blade of a bivalve speculum, and the test applied. If 
it change red test paper to a blue, this indicates that the 
secretion of the uterus is excessively alkaline. If the effect 
is simply to blanch the red paper, the secretion is not excess- 
ively alkaline. 

It will be found in practice that flexions or versions are 
the most frequent cause of sterility; but in case there is no 
flexion or version found, the cause must be looked for in 
other conditions I have mentioned. And I may further 
remark that an abnormally small os uteri, or narrow cervical 
canal, may be a cause of sterility, and, of course, is to be 
diagnosed by the effort to introduce the uterine sound and 
finding it impossible. Scanzoni denies that the very small 
os uteri may be a cause of sterility, as he has seen concep- 
tion take place when the os was no larger than a millet seed, 
and so have others ; but these are exceptional cases, and as 
a rule those patients are sterile, and will become fruitful 
when the os and cervix are dilated. I think the contracted 
os is in many cases found after impregnation, when it nat- 
urally contracts, and may have been much larger before 
impregnation took place. If, in attempting to diagnose the 
causes which produce sterility in a given case, we find the 
os very small, we shall not go far astray by deciding this to 
be at least one cause of the unfruitfulness. 

Some authors mention leucorrhoea and obstructive dys- 
menorrhcea as causes of sterility, but they are only symp- 
toms of the inflammation and displacements I have men- 
tioned. 



BARRENNESS AND STERILITY. 257 



Treatment. 



In looking over the great number of causes which may 
produce sterility, we must be impressed with the great variety 
of treatment required in different cases to afford relief. The 
treatment must be adapted to the removal of causes present 
in the particular case before us ; and unless we find incurable 
deformity or disease, we should proceed upon the assumption 
that treatment will be successful, and adopt those measures 
which offer the most encouragement for giving relief. Of 
course, when the deformity or disease is such as to cause a 
hopeless case of unfruitfulness (termed barrenness), nothing 
can be done with any benefit. In case, however, the disease 
or deformity is one which can be cured, or removed, it 
should be treated and relieved, whether the difficulty be con- 
genital or acquired. 

It is unnecessary in this connection to go over a descrip- 
tion of the treatment required in imperforate hymen, atresia 
of the vagina or cervix, contraction or elongation of the cervix, 
uterine polypi or tumors, and vegetations of the endometrium, 
endo-metritis or cervicitis, vaginitis or vaginismus, as they may 
be studied in other parts of this work under their proper 
heads. I will, however, say a few words regarding flexions, 
conjoined with contraction of the cervix. These require 
treatment either with sponge tents or bougies. The treatment 
requires some skill and patience. 

Usually in these cases of contraction of the cervix, either 
with or without flexion, there is present some degree of cer- 
vicitis, and attempts to dilate the cervical canal may produce 
very much pain and irritation. This may at times be so 
great as to affect the whole system, and produce such pro- 
found effects as even to endanger life. 

It is advisable, then, when we find a case in which there 
is considerable pain produced by even an attempt to make out 

a diagnosis, that we institute treatment for the relief of the 

17 



258 EATON ON DISEASES OF WOMEN. 

tenderness (at least till it is mostly removed), before we 
proceed to any attempt at dilation of the constriction. This 
can be accomplished by the daily use of very warm vaginal 
injections of water, with the application to the cervix of 
wads of cotton saturated with Glycerine, or smearing the 
cervix with dilute Belladonna ointment occasionally, and giv- 
ing internally Bell, or Aconite, according to the most promi- 
nent symptoms manifested by the patient, which are homoeo- 
pathic to these remedies. 

After getting the tenderness mostly or entirely removed, 
we proceed to introduce the smallest sized sponge tent, well 
smeared with Carbolized glycerine, as far up into the cervical 
canal as possible by means of the sponge tent holder (see 
chapter on instruments). I generally do this without the 
use of a speculum, using the middle finger of the left hand 
in the vagina to direct the tent into the os uteri, grasping 
the tent holder with the right hand, of course. The specu- 
lum can be used by those who prefer it. But I have found 
that its use gives usually more pain in these cases, as they 
have commonly a very narrow vagina, and the use of the 
speculum gives more pain than it does in women who 
have had children. The use of tents and bougies is to be 
carried out the same as in the treatment of dysmenorrhoea 
caused from flexions and narrowing of the cervical canal. 

I will again in this connection warn the student against 
the use of the tent at his office, and allowing the patient to 
go home with it inserted, although no serious results have 
happened in the few T instances in which I have done it. 
Others have not been so fortunate, and the death of the 
patient has resulted from this cause. 

Where dilation is well made, so as to include the inter- 
nal portion of the cervical canal, and the contraction again 
comes on, incising the cervix with the hysterotome (see 
chapter on Instruments), and following its use with the 
sponge tent for a day or two, and then substituting a tent 



BARRENNESS AXD STERILITY. 259 

made of linen cloth, tapering and of suitable size, is the 
proper treatment. These tents should be saturated with 
Carbolized glycerine, and a string should be fastened to them 
before they are introduced, to facilitate their removal. 

After the dilation is accomplished we may treat any 
endo-metritis which may be present, causing a leucorrhcea or 
the excessive alkalinity of the vaginal discharges with which 
some are affected, which destroys the spermatozoa, and which 
in part may cause the sterility. (See chap, on Leucorrhoea 
and Vaginitis.) 

In cases where the cause seems clearly to be atony or 
atrophy of the uterus or ovaries, remedies are of great 
benefit. Cantharides, JVux, Secale, Puis., etc., are often ben- 
eficial. A generous diet and out-door exercise may be rec- 
ommended. Prescribe oysters as a part of the regular diet. 
Pass a gentle current of electricity through the uterus and 
ovaries every two or three days. See that the bowels act 
properly and regularly. If they do not, prescribe warm ene- 
mas of soap and water, followed by a small injection of tepid 
water (after the bowels have moved), which may be allowed 
to remain in the bowel, and give the homoeopathically indi- 
cated remedy. Let all mental labor be abandoned for recrea- 
tion and gentle physical exercise. 

Want of compatibility is usually best remedied by the 
courts. Still the judicious, honest, honorable physician may 
sometimes bring harmony out of discord by timely, wise 
advice. 

Excessive sexual passion may require Kali bro. y Picric ac. 
or Camph. to restrain it, and these remedies are often useful 
in dyspareunia, vaginismus, etc., as well as excessive amative- 
ness. In these latter cases a plain diet, mostly consisting of 
vegetables and fruit, is advisable, allowing no stimulants or 
pastry, tea or coffee. 

We must bear in mind that the husband may not generate 
healthy semen ; hence, before deciding a lady barren (after 



260 EATON ON DISEASES OF WOMEN. 

feeling sure that her genital organs are healthy so far as we 
can learn, and we feel disposed to blame the ovaries or fallo- 
pian tubes for the sterility, and hence make out the case 
hopeless), we should ascertain if there may not be some fault 
in the husband's health or development which may explain 
the want of fecundation. Curling's work on diseases of the 
u Testis " may be studied with profit in this connection. 

When hemorrhoids or fissures of the rectum exist, they 
should be treated in the hope that their cure may not only 
bring comfort, but be a relief to sterility as well. These dis- 
eases probably cause sterility by making sexual congress 
painful, and hence preventing the sexual orgasm on the 
part of the female, as well as producing an irritable vagina, 
from which the semen is quickly expelled. Dr. Comstock,* 
of St. Louis, reports a case of sterility, aged thirty-one years, 
married ten years, in which he discovered a fissure situated 
half an inch within the anus. The patient suffered greatly in 
defecation or attempts at copulation; upon curing the fissure 
painful coitus ceased and she became pregnant six months 
afterwards. I have had a similar case, with a similar result, 
the past 3' ear. 

The cure of hemorrhage from the bowels may usually 
be accomplished with the use of Ars., Hamamelis, Ferr. per- 
sidph., Ipecac, or Aconite, according to their indications, 
and may cure the sterility in the case by restoring the sys- 
tem to greater vigor by stopping the loss of blood, so that the 
proper nutrition of the ovaries may take place, and the want 
of healthy ovulation be cured, hence relieving the sterility. 

Of course, in complete procidentia of the uterus and 
inversion of the organ sterility must be present; still by 
restoring the organ to normal position the patient may be- 
come fruitful. I have mentioned a case under the chapter 
on "Inversion," where conception took place after I had 
replaced the inverted organ. I have repeatedly seen it follow 

*Hale on Sterility, page 155. 



BARREA T NESS AND STERILITY. 261 

the cure of prolapse. For the treatment of these displace- 
ments see treatment of inversion and prolapse. 

The characteristic symptoms of the remedies which have 
been found of use in sterility are all I shall attempt to give. 
These are mainly useful in correcting the diseased conditions 
to which I have referred. These I take largely from Pro- 
fessor Hale's excellent work on " Sterility," to which the 
reader is referred in case he wishes an exhaustive treatise 
on this subject. 

Indications for Remedies. 

Aurum. — This remedy is secondarily indicated in amen- 
orrhoea, dependent on torpor of the ovaries, in scanty men- 
struation with chronic metritis ; in sterility dependent on 
these states, or due to "coldness" or female impotency with 
suicidal depression. (Dose, a few grs. of the 2 X or 3 X trit.) 

Gold is primarily indicated for symptoms similar to Plati- 
num, namely: Profuse and frequent menses, congestion of the 
uterus, increased sexual desire and mental or emotional 
irritability. (Dose, the 12 x to 30 x Trit.) I prefer the Au- 
rum mur., or the muriate of Gold and Sodium. 

Agnus Castus. — A complete loss of sexual power and 
desire ; amenorrhoea ; melancholy, etc. 

Aletris. — General debility; sterility after abortion; ina- 
bility of the uterus to retain the impregnated ovum. 

Apis Mel. — Ovaritis, chronic or acute, with stinging 
pains in the ovaries; stinging pains in any part of the pelvis 
or abdomen. 

Borax. — Chronic acrid leucorrhoea. (Hahnemann's 
"Chronic Diseases," Part II.) Membranous dysmenorrhoea; 
erosions of the os uteri ; aphthous affections of the vagina. 

Baryta Carb. — Loss of sexual desire and power ; scanty 
menses ; takes cold easily. 

Cantharides. — Sterility, with great sexual excitement 
(with loss of sexual passion, used in low dilution). 



262 EATON ON DISEASES OF WOMEN. 

Capsicum. — Fat sterile women complaining of feeling 
chilly ; amaurosis, with scanty menstruation. 

Calcarea Carb. — Sterility, in fleshy women, with leucor- 
rhoea ; very profuse or too frequent menses. 

Caladium. — Sterility, with melancholy ; fetid urine ; 
asthma ; loss of sexual power ; cold sweat of the sexual 
organs. 

Cannabis Ind. — Sterility, with great sexual excitement; 
w^ith urinal troubles, inflammation of the bladder, etc. 

Chimaphila. — Atrophy of the ovaries and mammae; 
urine full of mucus; scaly eruptions of the skin. 

Conium. — One of the best remedies in sterility ; acrid 
leucorrhoea ; scant menses; pain and swelling of the breasts. 
(Tr. Conium should be made from the unripe seeds. — "Hale.") 

Cimicifuga. — Sterility, with spinal irritation; want of 
vitality in the ovaries ; pain in the ovarian region. (I have 
known many cases of sterility cured with Cimicifuga when 
all other means failed. — "Hale.") 

Caulophyllum. — Sterility, with spasmodic dysmenor- 
rhoea; patient subject to rheumatism. 

Eupatorium Purp. — Sterility in women who suffer from 
nervous exhaustion; loss of sexual desire; frequent abortions. 

Grossypium. — Sterility, with atony of the uterus ; gen- 
eral debility; a flabby state of the uterine tissues. 

Helonias. — Sterility, with chlorosis ; debility ; diabetes ; 
prolapsus uteri ; anaemia. 

Iodine. — An excellent remedy ; sterility, with weakness ; 
general debility; atrophy of the mammae; goitre. Iodine 
increases the sexual appetite. Valetudinarian women, who 
have been married a number of years without children not 
infrequently become gravid after a thorough course of Iodine. 
(Tully.) The "Encyclopaedia of Mat. Med.," Vol. V, says 
that "a case is said to have occurred where the female be- 
came sterile soon after commencing the use of Iodine. Before 
she commenced the use of the Iodine she gave birth to a 



BARRENNESS AND STERILITY. 263 

child annually ; but from the time of commencing its use* to 
the present — a period of eight years — she has never become 
pregnant." (Hale, p. 189.) 

Bromine has a similar effect to Iodine. 

Iodide of Lead. — Sterility, with atrophy of the ovaries. 

Iodide of Potassium {Kali liydriodicimi). — Similar to 
Iodine. 

Kali Carb. produces sterility (Hahnemann's " Chronic 
Diseases ") ; therefore, it should cure those cases, if leucor- 
rhoea appears to be a prominent symptom, with debility. 

Bromides. — All the Bromides benumb the sexual desire, 
and cause a partial paralysis of the reproductive organs. In 
high attenuation they are indicated in sterility caused from 
sexual inactivity. Give low in cases of excessive sexual 
passion, to relieve sterility. 

Phosphorus. — The greatest remedy we have in cure of 
sterility. (See Hale on " Sterility," p. 193.) It closely re- 
sembles Cantharides in its action on the female genitalia. 

Phos. Acid. — Similar to Phos. 

Platinum. — Sterility, with melancholy ; changeable mood 
from day to day ; hysteria, with onanism ; excessive sexual 
passion. 

Pulsatilla. — Sterility, with delayed or scanty menstru- 
ation ; entire suppression of the catamenia for years, with 
sterility. (I have known Puis., two doses of the 3 X , in sev- 
eral cases, at once cause the flow to appear, and conception 
to take place within a few weeks, where the suppression had 
been of years' standing.) 

Ruta. Grav. — Sterility, following abortion, with leucor- 
rhoea. 

Sabina. — Sterility, with profuse menstrual flow ; conges- 
tion or ulceration of the uterus. Compare with Erigeron, 
Trillium, Crocus, and Calcarea. 

Secale Cor. — Sterility, with irritable uterus ; frequent 
miscarriages; uterine hemorrhages (use 6 X to 12 x attenuation). 



264 EATON ON DISEASES OF WOMEN. 

Sepia. — Sterility, with acrid leucorrhoea. 

Stillingia. — Sterility, from syphilis or abuse of mercury. 
Compare with Kali iodatum, Phytolac. dec, Aurum, etc. 

Ustilago. — (Similar in its action to jSecale, Caulophyllum, 
and Cimicif.) 

In cases of vaginismus, conception may follow copula- 
tion, used under the influence of an anaesthetic. This should 
be, however, a last resort, and can only be advised when 
the parents are exceedingly anxious to have offspring. The 
student will find occasionally a case where every thing seems 
favorable to conception, and still the patient will remain 
sterile. In such cases attention to the husband is advisable. 
The treatment of his case does not, however, come properly 
under discussion here. 



DISEASES OF THE OVARIES. 265 



CHAPTER XXIII. 

DISEASES OF THE OVARIES. 

Tumors of the ovaries and inflammation of these organs are 
discussed under special heads in this book. Effusion of blood 
as a result of the bursting of the Graafian follicle is treated 
of under the head of recto-vaginal hematocele. 

Malformation of Ovaries. — The ovaries may be rudi- 
mentary or absent. When absent the woman or person is 
sexless ; when one exists in a normal condition, all other 
parts being normal, the woman may conceive. Usually, in 
cases of absence of the uterus, the ovaries are also absent. 
Two cases are mentioned in Ziemssen's Cyclopaedia, vol- 
ume X, where there was a supernumerary ovary. 

Ovaritis. — Inflammation of the ovaries is of quite com- 
mon occurrence. They may both be inflamed at the same 
time, but it is most common that only one is affected. The 
left ovary is most frequently affected by inflammation. This 
may be due to its nearness to the colon and rectum, as it 
may be pressed upon from a large distension of this part of 
the bowel. This affection is a very painful one. The ovaries 
are seen to be liable to inflammatory action when we notice 
the monthly ovulation which takes place in them. Professor 
Ludlam has spoken of this ovulation as a traumatic lesion; 
but we can hardly consider the irritation in the system by 
this process of ovulation as a case of surgical fever, though 
in the escape of the ovum there is some laceration of the 
tissues of the ovary in the rupture of the Graafian vesicle at 
each menstrual epoch ; and, although there is a considerable 
increase in the activity of the circulation, we can not term 
this, when only normal, as any thing more than a physiology 



266 EATON ON DISEASES OF WOMEN. 

ical condition, though, without doubt, it predisposes to dis- 
eased action. The ovary is more susceptible to the action of 
cold at the menstrual period than at other times. 

The inflammation in the ovary may be acute or sub-acute. 
The sub-acute variety may exist for a long time, and be the 
cause of painful menstruation; or, at least, produce pain 
mainly at the menstrual period ; but in these cases the disease 
is generally connected with uterine irritation. The acute 
form of ovaritis may supervene on the sub-acute, owing to 
some unusual excitement, fatigue, or from cold and exposure. 

Ovaritis seldom exists independently of other pelvic com- 
plications, such as peri-metritis, endo-metritis, or general 
pelvic cellulitis. 

The acute inflammation in the ovary may exist as a pri- 
mary affection, and the inflammation commonly connected 
with it in the peritoneum, fallopian tubes, or pelvic veins 
may be secondary to it. 

The ovary consists of a nucleated, tough, fibrous connec- 
tive tissue, with considerable fusiform muscular tissue, form- 
ing the stroma — in this stroma are embedded the ovules of 
Dr. Graaf. Their number, as seen with the naked eye, varies 
from five to twenty; but, with the microscope, hundreds 
are seen of very minute size ; in various stages of develop- 
ment. Hence, we may understand the ovary to be a mass 
of eggs in various stages of development, imbedded in this 
stromous tissue, surrounded as a whole by two tunics or cov- 
erings, the outer one consisting of peritoneum, the inner one 
of fibrous tissue. These vesicles, of which the ovary is com- 
posed so largely, vary greatly in size, the most fully devel- 
oped being nearest the surface. Throughout the structure 
of the ovaries permeate an intricate network of blood vessels 
and nerves. The absorbent glands are few. The ovaries 
are supplied with blood by the ovarian branches from the 
aorta, and the nerves are from the spermatic plexus. The 
absorbents empty into those of the kidney. 



DISEASES OF THE OVARIES. 267 

The ovum in its escape from the ovary, at the monthly 
period, or otherwise (the rupture of the Graafian vesicle may 
take place, with some women, at any time, especially during 
great sexual excitement), bursts through the fibrous and per- 
itoneal coats of the ovary. Now, in cases of inflammation 
and thickening, and consequent toughening, of these coats, 
from chronic, or rather sub-acute, inflammation of these parts, 
the matured egg may fail to escape. This failure to escape 
of the matured ovum may cause, by its retention and pres- 
ence, an increase of irritation, and form the nucleus of an 
ovarian cyst or abscess, through inflammation in the cyst. 
This may develop largely, and other ova may also be retained 
from the same cause, and develop other cysts. Or we may 
have impregnation of this retained ovum in the ovary, pro- 
ducing ovarian pregnancy, which, however, results in an 
abortive attempt to develop a foetus, and we have, as a re- 
sult, a fibro-cystic growth, containing bones, teeth, hair, etc., 
termed dermoid tumors. Or we may have a retention of these 
ova, and the production of no special development of a dis- 
eased nature. In this instance, if both ovaries were affected, 
we would simply have sterility as a result. 

We may have acute inflammation in the parenchyma of 
the ovary. It may affect one only, or both at the same 
time. This active inflammation may result in resolution, ab- 
scess, hypertrophy, induration, softening, or melanosis, or 
leave a sub-acute inflammation behind it, which may lay the 
foundation for the development of scirrhous, encephaloid, or 
simple fibrous tumors, though fibro-cystic growths in the 
ovary are more common than fibrous. 

The engorgement of blood in cases of acute inflammation 
is enormous. If not speedily relieved, pus is formed, and 
finds an exit, by ulcerative inflammatory action, into the vag- 
ina or rectum, urinary bladder or pelvic cavity, or works its 
way along the course of the round ligament, and finds exit 
at the inguinal ring; or it may be discharged into the peri- 



268 EA TON ON DISEASES OF WOMEN. 

toneal cavity, in which case the fatal result can be delayed 
but a few days. I have seen it point and be discharged in 
the iliac region, and the patient recover. 

Gangrene of the ovary may result from acute ovaritis, 
according to some authors ; but I have never seen a case. 

Ktiolojo. 

Suppression of catamenia from cold is the most frequent 
cause of ovaritis, causing first congestion, and then inflam- 
mation. Remedies to cause abortion may sometimes prove 
active agents to produce inflammation in these organs. Fre- 
quent and excessive coitus, self-abuse, or nymphomania, or a 
severe cold taken just after or during menstruation, may 
conduce to the development of active inflammation in the 
ovaries. Or the inflammation may be the result of its exten- 
sion from neighboring viscera, or organs, which have been 
primarily affected. 

Sometimes acute ovaritis may supervene upon difficult 
labor, in which case it is probably due to bruising the ovaries 
against the bony pelvis in the severe throes of labor, in cases 
where the head of the child is very large. It may result 
from acute gonorrhoeal inflammation, by continuity of inflam- 
mation through the uterus and fallopian tubes ; or gonorrhoea 
may cause ovaritis by sympathetic or glandular action. In 
this case it corresponds to the gonorrhoeal orchitis in men. 

Diagnosis. 

The diagnosis is not always plain, although, with the ex- 
ercise of some care, we may usually be correct. We are 
most likely to confound the disease with pelvic cellulitis and 
colitis. 

Chronic Ovaritis may be overlooked by most physicians 
who have not given diseases of women special study ; but as 
the results of sub-acute chronic ovaritis are so disastrous, it is 
well to be on the alert to discover and remedy it, if possible. 



DISEASES OF THE OVARIES. 269 

The deep seated burning pain in the pelvis or in the iliac 
regions, should lead us to suspect this difficulty, especially 
when the pain is aggravated by pressure, motion, or the erect 
posture. Some cases suffer only moderately, except at the 
monthly periods, when the pain becomes excessive. By 
introducing the finger high into the rectum, and making 
strong downward pressure with the other hand just above 
the pubis, we may generally feel the enlarged and tender 
ovary. We must be careful not to mistake the uterus for 
the ovary, and conclude that as pressing the finger against it 
does not produce pain, consequently we have no ovaritis. 
But the uterus and ovaries must be carefully distinguished. 
In cellulitis the enlargement will be felt more extended in 
most cases, and will appear immovable, while the inflamed 
ovary is movable. If the tenderness is so great that we 
can not well make a physical examination, we had better give 
an anaesthetic and proceed. Though this excess of tender- 
ness is indicative of cellulitis it may mean very active ovar- 
itis, either alone or in conjunction with cellulitis ; differentially 
we should examine through the vagina, when Ave will find, if 
cellulitis be present, a hard enlargement in the upper and 
posterior portion of the vagina, which will appear firm and 
immovable, as if attached to the bony pelvis. This we do 
not find in an uncomplicated case of ovaritis. We find some 
tenderness on pressure in the iliac region, and, if the inflam- 
mation is active, we soon have an extension of the inflam- 
mation and tenderness over the most of the entire abdomen, 
causing the patient to semi-flex the thighs and limbs and lie 
square upon the back, or the side well turned on the face. 
With active inflammation we have rigors, high fever, the 
wiry pulse, rapid respiration, great prostration of strength, 
nausea, etc. 

Treatment. 

In acute ovaritis the most efficient remedies I have found 
are Aconite, till the pulse is softened, then Secede, Macrotis, 



270 EATON ON DISEASES OF WOMEN. 

Ars., Bell.. Brjj., or Puis. If the disease goes on to suppura- 
tion, Merc, Lachesis, China, Ars., Hepar sulph. may be indi- 
cated. Warm hip baths, and warm water vaginal injections, 
with warm foot-baths, are of service in the acute form. Rest 
in the recumbent posture, and keeping the bowels moved 
with enenrne, is imperatively necessary. In case pus forms, 
which it is likely to do in twelve or fifteen days, unless the 
disease is moderated by treatment, it is known to have 
formed by the occurrence of rigors and chills. If matter 
can be detected, we may evacuate it, if possible, through 
the posterior walls of the vagina, by means of a long, aspi- 
rating needle, or the curved trocar, retaining the canula in 
the abscess for a few days, to secure the thorough drainage 
of the abscess, and prevent its discharging the pus into the 
cellular tissue between the vagina and rectum, which would 
awaken a cellulitis, and probably produce pelvic abscess. 
Where there is distinct pointing of the abscess in other 
localities, it may be evacuated with the trocar or aspirator 
artificially, either in the iliac region, or in the linea alba; in 
some instances, sometimes, the escape of the matter is spon- 
taneous, through some of the natural outlets of the pelvis 
(the vagina, rectum, or urethra). In some cases it may be 
necessary to use a stimulating injection into the abscess to 
cause adhesions of its walls. For this purpose the Comp. 
tr. iodine, twenty drops to the ounce of water, is, perhaps, 
the best remedy known. This may be repeated every day 
for a week or two; and if adhesive inflammation does not 
result, we may increase the strength of the injection till it 
it is efficient. 

Nourishing diet is to be given. Sometimes egg-nog, 
beef tea, and the like, are demanded by the prostration. 

When only one ovary is affected, conception has been 
known to take place. In chronic ovaritis, the treatment 
should in the first instance be directed to removal of- the 
cause, if possible, whether it be onanism, excessive venery, 



DISEASES OF THE OVARIES. 271 

or amenorrhoea. If Ave are successful in removing the cause 
we may expect a speedy subsidence of the irritation, unless 
it has progressed to softening or induration, in which case 
we can not look for rapid relief, and we are likely to have 
sterility remaining at best. 

In the sub-acute form it is of the utmost importance that 
the disease be early diagnosed, and relieved before serious 
consequences have resulted, prevention being better than 
cure. 

The treatment of ovarian dropsy and tumors, etc., which 
may arise from ovaritis will require separate chapters for 
their discussion. I will say, however, that there are cases 
of hypertrophy of the ovary, resulting from ovaritis, which 
may be greatly diminished in size, and sometimes cured, by 
the external and internal use of Iodine. Just the condition 
of the ovary in some cases of enlargement Avhere death does 
not ensue, it is impossible to always know. But that en- 
largement of the ovary to a considerable extent may dimin- 
ish in size, and sometimes disappear entirely, I assert. 
The history of two or three cases I will give in illustration. 

Mrs. H., aged about thirty-five years, native of Illinois, 
married, mother of three children, youngest aged four years, 
consulted me April 10, 1874, in regard to a "tumor in her 
side." She stated that it had been observed for over a year, 
and was gradually increasing in size. On making a phys- 
ical examination I found the tumor to consist of an enlarged 
movable ovary. It occupied the entire left iliac region, and 
rose one-half the way up into the left lumbar region. It 
impinged somewhat upon the hypogastric region as well ; but 
occupied the left iliac completely. The uterus I found 
healthy, though somewhat higher in the pelvis than natural. 
The sound indicated no enlargement or tenderness of the 
uterus. The tumor was only slightly tender to the touch. 
Menstruation had been normal and regular. 

She had become alarmed at the prospect of having to 



272 EATON ON DISEASES OF WOMEN. 

undergo the operation of ovariotomy, which had been told her 
was necessary by other physicians who had examined her. 
She had been sent to me, as her family physician afterwards 
told me, to have the operation performed. General health of 
patient was good, though from loss of sleep and from de- 
spondency she had some little gastric irritation. She seemed 
almost crazed by the idea of an operation, and desired that 
every other means be used to relieve her. (I had the 
year before treated a somewhat similar case, with a diminu- 
tion of at least one-half in the size of the tumor in two 
months, when the lady left the city and I lost sight of her, 
and I have not yet learned the result.) I accordingly told her 
I would try what remedies would do for her, thinking at least 
I would do her no harm, and as time was not important in 
her case, I would see if she could be benefited, though I 
could arrive at no very definite cause of the disease. 

The menses had been somewhat painful for about eighteen 
months, at the commencement of which time she had been 
troubled with an attack of inflammation of the womb, caused 
from a cold, as she supposed from what her physican had 
told her. I accordingly put her upon Merc, protiodide 3 X for 
about a week, giving a powder every three hours ; then upon 
Iodine 6 X at same intervals. I sometimes for a few days gave 
Iod. Merc, or Ars.; but mainly Iodine in some form or combi- 
nation, and externally over the entire surface of the abdomen, 
distended by the tumor, I had painted once or twice a day 
Tr. Iodine. Sometimes, owing to the tenderness of the skin, 
I would omit the Tr. and apply Iod. and Glycerine for a few 
days, and return again to the Tr. alone. Sometimes, for a 
few days at a time, I had warm, wet compresses applied over 
the tumor, covered with dry flannel and held in place with a 
bandage. 

I pursued this treatment thoroughly, and had the satisfac- 
tion of seeing the tumor diminishing in size after about six 
weeks' treatment; after that the diminution was quite con- 



DISEASES OF THE OVARIES. 273 

stant, though slow, for about nine months, till it finally could 
be felt no more. After three or four months' treatment it 
required a little pressure to feel it. It was then about the 
size of two fists; it went down smaller and smaller till it dis- 
appeared, as I said before. Now, June, 1880, I know the 
lady to be still free from any trouble, and there has been 
no return of the enlargement of the ovary, now over five 
years since I treated her. Her gratitude and joy is, of 
course, unbounded. 

Another Case. — Mrs. N., aged about sixty years, widow, 
mother of six children, youngest about eighteen years of age, 
consulted me by the advice of friends on account of a tumor 
in the side of her abdomen, which, from its weight, gave her 
much trouble, she being obliged, from its size and weight, to 
stoop very much in walking. She stated that she had first 
noticed the tumor of small size in the left iliac region, about 
twenty-six years before; that it was tender for some years, 
and increased very slowly in size till after the birth of her 
last child, when it increased quite rapidly. After she had 
noticed the tumor she had borne two children. Her general 
health had usually been quite good, though at times she suf- 
fered much from constipation and somewhat from indigestion 
and flatulency, and the tumor had always felt hard. 

She stated that in former years she had consulted several 
physicians, who had all agreed that it was an ovarian tumor, 
and advised its removal by operation. This she had refused 
to submit to, and had thought that for fifteen years it had 
remained about the same size. It seemed, of late, to incon- 
venience her more from its weight, or she seemed to suffer 
more from it with some cystic irritation, causing frequent 
desire to micturate. 

I had little or no hope of effecting a diminution of the 
growth, but made a careful examination; found the tumor 
clearly ovarian, extremely hard almost like stone, rising and 
enlarging from the left of the pubis, upwards to a little above 

18 



274 EATON ON DISEASES OE WOMEN. 

the umbilicus, occupying the left side of the abdomen and 
distending it. The uterus was normal though rather small, 
as is usual with women of this age. 

I had her under my personal care for about three months, 
when the tumor had decreased considerably and softened 
very materially. She returned home, and her physicians 
continued treatment, which was similar to that used in the 
preceding case all through. I saw her about a year after- 
wards, when she could and did walk quite erect; the tumor 
had diminished fully two-thirds, and gave no inconvenience ; 
since which time she has discontinued treatment, and I hear 
from friends that she remains quite well still, with the tumor 
about the same as when I last saw it. 

Many other cases, not quite so striking as these, where 
the enlargement had been of shorter duration, or less in size, 
I have entirely cured with this plan of treatment. In some 
cases I have failed, the tumor going on to greater and greater 
development. Possibly some of them have not been thor- 
ough in the treatment, as I have had the personal care of 
only three or four of the cases of failure. 

The conclusion to which I come is this, thut there are 
cases of induration and hypertrophy of the ovary which are 
not urgent, where we may well make the trial to promote 
absorption. If we fail, nothing is lost ; if we succeed, much is 
gained. Some may claim that these cases reported were 
"fibroids of the uterus." If they were, the result was satis- 
factory. It is impossible to prove either that they were or 
were not pedunculated fibroids of the uterus. The evidences 
seemed clear to me, and the other physicians who saw the 
cases, that they were ovarian hypertrophy and induration. 
Fibro-cystic tumors of the ovary can not be cured this way. 
(See Ovarian Tumors.) 



OVARIAN TUMORS. 275 



CHAPTER XXIV. 

OVARIAN TUMORS. 

In a work on i; Diseases of Women" we can not go as 
fully into the discussion of this subject as has been done 
by Prof. Peaslee, who has given us a work of five hundred 
and fifty pages upon this topic alone. To Profs. Peaslee, 
Ludlam, Gross, Byford, Danforth, Scanzoni, Kiwisch, Beck- 
with, Hunt, and others I am under obligation for useful 
suggestions. 

I will endeavor to present practical points for the guid- 
ance of the student in diagnosis, etiology, and treatment, 
with as little as possible of speculative theories, developing, 
as well as I am able, the homoeopathic treatment. 

Classification of Ovarian Tumors. — Ovarian tumors may 
be considered in three classes — the solid, cystic, and com- 
pound; the solid consisting of solid material; the cystic 
being fluid within a sac, or cyst; the compound being com- 
posed in part of solid and part of fluid material. 

The solid ovarian tumors are : 

1. Fibroma; 

2. Enchondroma; 

3. Osteoma; 

4. Carcinoma; 

5. Papilloma. 
The cystic ovarian tumors are : 

1. Hydrops Folliculorum ; 

{Struma ; 
Oligocysts ; 
Poly cists ; 
3. Dermoid Cysts. 



276 EATON ON DISEASES OF WOMEN. 

Etiology. 

The causes of ovarian tumors are not well understood. 
Peaslee says : " Nothing is positively known of the cause 
of ovarian tumors." Scanzoni maintains that hyperemia of 
the ovary causes the disease. Dr. T. S. Lee admits marriage 
to be a frequent cause; while Dr. Chas. Clay asserts that 
the number of ovarian cysts in the married and unmarried 
is about equal. Drs. Rose and Lever support the hereditary 
nature of the disease; while others maintain that sterility 
is a frequent cause of ovarian tumors. 

Now, we think all are right in part, and that sterility, 
marriage, hyperemia, parturition, etc., may sometimes tend 
to the production of the disease; but, if we state that sub- 
acute chronic ovaritis is the cause of ovarian tumors, we 
think we would be expressing, in most cases, the true cause 
in few words. This sub-acute chronic ovaritis may be caused 
by unsatisfied sexual passion, as well as excessive venery, by 
severe labor, by inflammation extending from the uterus in 
cases of metritis, or from the peritonaeum in case of peri- 
tonitis, or from pelvic cellulitis, resulting from cold, abortion, 
or puerperal peritonitis. Either of these conditions, as well 
as onanism, may produce the condition of chronic sub-acute 
ovaritis; and the scrofulous diathesis may predispose the 
patient to the development of the disease. 

I do not intend to say that we will be able, in all cases, 
to make out, from the history of the case, positive evidence 
of the chronic sub-acute ovaritis, for the reason that the symp- 
toms in these cases, being often somewhat obscure, may not 
have been noted, and, as we are not likely to see the case 
in its entire development, we may not be always able to 
trace the disease satisfactorily from its incipiency. Prof. 
Byford, I notice, leans to this view of the case. He says : 
" Inflammation of a low grade and somewhat chronic dura- 
tion misfht cause induration or thickening of the indusium, 



OVARIAN TUMORS. 277 

so that it would not yield to the upheaving pressure of the 
ovisac." Prof. Gross attempts no explanation of the cause of 
the development of ovarian tumors. So far as I can learn, 
those who claim sterility, marriage, or maternity as causes of 
ovarian tumors offer no explanation of the modus operandi. 

We are of the opinion that any thing which acts to 
produce a chronic irritation in the ovaries may be considered 
a prime cause of the disease. In some instances the cause 
is so obscured as to be undiscoverable. That the married 
state may tend to develop the disease, by causing chronic 
sub-acute inflammation of the ovary, by reason of excessive 
sexual congress, or too long continued and incomplete excite- 
ment, or resulting from abortions, or poor recovery from 
confinement, I do not deny; and they may become subject 
to ovarian Dermoid cysts as a result of extra-uterine con- 
ception (ovarian), according to Cruveilhier, and as we 
believe. 

The idea, of ovarian cysts being formed from the ovisac 
has been adopted by Scanzoni, Velpeau, Cruveilhier, Negrier, 
Hertz, Hodkin, Paget, Farre, Huguier, and others. Roki- 
tansky considers them to result from an elementary granule, 
which grows by intussusception into a nucleus, and then into 
a structureless vesicle. Dr. Peaslee says : " The oligocyst 
commences as a dropsy of the ovisac, and may practically 
be considered simply as a larger development of the hydrops 
follicidi, and the polycist as a colloid degeneration of the ova- 
rian stroma.'' Rokitarisky * has demonstrated the possibility 
of a cyst to form from a ruptured Graafian follicle; or, in 
other words, from a corpus luteum, and Prof. Emmettf has 
seen one such case. After the closure of the opening, where 
the Graafian vesicle ruptured, the corpus luteum developed 
into a cyst ; but this method of development must be very 
rare, and even the authors quoted do not make the matter as 

* AUg. Wiener Med., Z. 1859, No. 34, Lehrb. 3, Aufl. p. 48. 
tPage 760, Emmett's " Prin. and Prac. of Gynecology." 



278 EA TON ON DISEASES OF WOMEN. 

plain to my mind as I could desire. Still they may be cor- 
rect, that the possibility exists for the development of cyst- 
oma in this way. 

These cases, however, are exceptional to a degree which 
makes them unworthy of more than a passing notice. But to 
a failure to rupture of the Graafian vesicle owing to the thick- 
ened condition of the indusium caused from slow inflamma- 
tory action, producing exudation of organizable plastic material 
over the surface of the ovary, is probably <lue the large ma- 
jority of cases of cystoma. Rindfleisch * has detected ova 
in the primary cyst. The cause of dermoid cysts being at- 
tributed to ovarian conception seems plausible enough. Still 
we must remember that dermoid cysts have been found in the 
testicle, and, in a few instances, in the kidney, bladder, scro- 
tum, brain, stomach, and behind the peritonaeum, on the pos- 
terior walls of the abdomen. 

In view of these facts, we must conclude there is some 
other method of formation of the dermoid cysts besides im- 
pregnation. The congenital development of these cysts has 
been offered, by Boinet, as an explanation, considering that 
two ova were impregnated at the same time in the uterus of 
the mother, and that, by some means, the one was partially 
developed within the other. How the one ovum got within 
the other he does not explain. I will suggest as a possible 
explanation that the ovum which became impregnated con- 
tained another ovum, owing to abnormal development of the 
parent ovum (so to speak) within the ovary — this impregna- 
tion resulting in the development of a perfect foetus, with 
the exception of this blighted second ovum within the first, 
which was sufficiently impregnated to produce parts of a 
physical frame, as skin, bone, teeth, hair, etc., these being 
contained within a sac, and being located, accidentally, in any 
part of the living foetus. If this theory is correct, we read- 
ily see why it is that these dermoid cysts are more frequently 

* Peaslee, p. 44. 



OVARIAN TUMORS. 279 

found in the ovary or testicle than in other localities within 
the body, which observation has shown to be the case. 

Fibrous, cartilaginous, and osseous tumors of the ovary 
are as clearly due to sub-acute, inflammatory action as are the 
purely cystic; this inflammatory action causing an effusion 
of plastic material, which takes on organized growth through 
a mysterious action in nature (though, perhaps, it is no more 
mysterious than the deposit of plastic material between the 
ends of a fractured bone, finally developing into an osseous 
formation firmly connecting the fragments). Acute inflam- 
mation of the ovaries may leave a sub-acute ovaritis, which 
may tend to produce ovarian tumors, and in this way the acute 
inflammation may be a cause of ovarian growths. 

I would not say that sterility caused ovarian tumors, but 
that the same cause that tends to produce sterility in some 
cases also tends to produce ovarian growths. We have ova- 
rian tumors affecting only one side, and the patient conceives, 
the ovum coming from the healthy ovary, and pregnancy goes 
on in some of these cases to full term, and a healthy child is 
delivered, though usually, if the ovarian tumor is of consider- 
able size during gestation, the child is weakly, owing to the 
unusual pressure to which it has been subjected within the 
abdomen, because of the presence of the tumor there at the 
same time. 

Derangements of menstruation, w T hich some authors have 
stated to be a cause of ovarian tumors, I think may be con- 
sidered as accompaniments, or caused from the same or 
similar conditions, rather than as causes. In cases of mon- 
orrhagia preceding the discovery of an ovarian growth, I 
find that the excessive flow is due to sub-acute endo-metritis, 
and in conjunction with this affection we have the chronic 
sub-acute ovaritis, either from extension of the inflammation 
from the uterus to the ovary or vice versa. But I can not 
see how derangements of menstruation can more than indi- 
rectly tend to the production of the pathological condition 



280 EATON ON DISEASES OF WOMEN. 

which would develop ovarian tumors. Cases do occur, 'tis 
true, where derangements of the menstrual function (the 
menses are sometimes scanty or absent, and sometimes ex- 
cessive) precede the discovery of ovarian disease; and we 
sometimes have an unusual amount of pain at the menstrual 
period in these cases; but I would refer the pain to the 
sub-acute ovaritis, as I would the development of the ovarian 
growth, and not to the excessive or diminished flow. In so 
far as sudden suppression of the menses from cold may affect 
the ovary to produce congestion, however, it may indirectly 
tend to the production of a condition of induration or inflam- 
mation of the organs, so that, in the course of time, an 
ovarian tumor might result. 

Marriage. — From all I can gather, statistical or other- 
wise, I conclude marriage has little effect in the development 
of ovarian cystoma. Dr. Churchill believes that those who 
have borne children are more liable to cystoma; while Dr. 
I. B. Brown finds that the larger number of married patients 
with ovarian tumors have not had children. Dr. Peaslee's 
experience is the same; while my own is that the number of 
married ladies afflicted with ovarian cystoma have been about 
equally divided between those who have borne children and 
those who have not. 

T. Stafford Lee concludes that disappointed affection is 
the most active predisposing cause. With this I can not agree. 

Age. — Cystoma is most frequently developed between the 
ages of twenty-five and forty years, showing that the period 
of the greatest ovarian activity is the period most favorable 
to the development of ovarian tumors, though exceptionally 
they have been known to occur in the very young and in 
the old. 

The disease is sometimes congenital, or develops in 
infancy, though very rarely so. Dr. T. Gr. Thomas* reports 
to the New York Obstetrical Society a case occurring in 

* Amer. Jour, of Obstetrics, 1880, p. 118. 



OVARIAN TUMORS. 281 

New Jersey in the practice of a physician, whom he does 
not name, but who sent the tumor to him, with the following 
report of the case : " The child was delivered by him at 
full term, and nothing abnormal was discovered at the time. 
About one month after birth a tumor was discovered in the 
iliac fossa. The child was well developed at birth, but soon 
showed signs of impaired nutrition, became emaciated, grew 
slowly, and languished till three years and five months old, 
and died. Autopsy revealed the existence of an ordinary 
ovarian cyst, filling the abdomen. The remains of the fallo- 
pian tube and ovary were upon one side of the tumor." 
This case seems to have been of congenital origin, although 
the development of the tumor occurred subsequent to birth. 
Pressure from the Rectum. — It has been thought by some 
that the left ovary was the most frequently affected, owing 
to its near relation to the rectum in the pelvis ; but statistics 
do not prove this to be true, but that the right and left ovary 
are about equally affected. In fact, the preponderance of ev- 
idence is rather in favor of the right ovary being most fre- 
quently affected; as Dr. Charles Clay reports, that, of eight 
hundred and fifty cases examined, two-thirds were of the 
right side and one- third on the left. In four hundred and 
fifteen cases observed by Drs. Scanzoni, Lee, West, and Che- 
veau, the right ovary was affected alone in two hundred and 
one instances, the left alone in one hundred and forty-eight, 
and both in sixty-six cases. This seems certainly to disprove 
that the left is most frequently affected. 

Symptoms. 

It is sometimes the case that in the first stage of devel- 
opment of ovarian tumors the patient experiences no peculiar 
symptoms, and the growth is first observed as a tumor of 
considerable size in the right or left iliac region, and even 
then giving no discomfort. In other cases the patient expe- 
riences those symptoms considered as indicative of general 



282 EATON ON DISEASES OF WOMEN. 

pelvic inflammation, or of inflammation of some one of the 
pelvic organs. A sense of weight in the pelvis is experi- 
enced, with a feeling of uneasiness; defecation is difficult 
and painful; indigestion, nausea, and flatulency are complained 
of; and, in fact, all the general symptoms of uterine disease 
are sometimes present ; and it may be observed that we have 
in some patients a complication of uterine inflammation, cell- 
ulitis, etc., in the case, and these general symptoms are due, 
in large part, to these complications. 

The peculiar symptoms of ovarian inflammation are most 
likely to be present, and, in some instances, displacements of 
the uterus in the form of retro-version or prolapse are present, 
having resulted by the weight of the enlarged ovary ; and 
the difficult defecation is due to the pressure of the enlarged 
ovary against the rectum. The pressure of the distended 
rectum and the straining at defecation tend to produce down- 
ward displacement of the ovary, and, with it, retro-version, 
retro-flexion, or prolapse of the uterus. In some cases the 
breasts enlarge, and there is a secretion of milk in them. 
The menstrual flow is sometimes greatly diminished, some- 
times excessive, and sometimes normal. Diarrhoea is some- 
times caused by the extension of irritation from the ovary to 
the rectum. Tenesmus is usually very annoying, in these 
cases troubled with diarrhoea. 

On vaginal examination a tense, though somewhat fluctu- 
ating, mass may be felt in the posterior cul-de-sac ; the uterus, 
being crowded anteriorly in the pelvis, often produces irrita- 
tion of the urethra, and a frequent desire to micturate, which 
is accomplished with considerable pain of a smarting or burn- 
ing character. 

Rectal Examination. — By a rectal examination we may 
more clearly ascertain the nature of the difficulty. The ova- 
rian cyst is almost always round and uniform in shape, and 
the feeling of fluctuation, as of a fluid within a sac, is to be 
noticed. There are several conditions liable to be mistaken 



OVARIAN TUMORS. 283 

for the ovarian cyst in its first stage ; viz., extra-uterine 
pregnancy, tubal dropsy, or cyst of the broad ligament ; but 
of these I will speak under the head of Differential Diagnosis. 

Second Stage of Development. — When the sac enlarges 
sufficiently to rise above the pubis, it is called its second 
stage of development. The uterus will now usually be found 
lower than normal in the pelvis, although, when the tumor 
reaches a size sufficiently large to rest upon the brim of the 
pelvis, the uterus may be drawn up higher than natural. The 
rectal examination, conjoined with the vaginal, will reveal the 
absence of the fluctuation discovered in the first stage, al- 
ready mentioned as located in the posterior part of the vag- 
ina, or, in some cases, laterally. The tenesmus and dysury 
are relieved entirely, or in a great measure. We find the 
tumor occupying one of the iliac regions, and impinging upon 
the hypogastric region. The tumor is fluctuating, though it 
requires some dexterity of touch to discover the fluctuation, 
owing to the resistance of the abdominal walls. As the 
tumor increases in growth, the bladder is pressed upon and 
displaced downwards, and we again have the desire for fre- 
quent micturition. 

The commencement of the third stage is marked by the 
tumor reaching to the umbilicus. The small intestines are 
crowded behind and above the tumor, so that we now have 
dullness on percussion over it. The fluctuation is now more 
distinct. 

The fourth stage is simply a continuation and increase of 
the third, and is characterized by the pressure of the tumor 
upon the abdominal viscera to the extent that we have a 
diminished action of the kidneys, indigestion, loss of appe- 
tite, nausea, sometimes diarrhoea or constipation. The press- 
ure is often so great as to interfere with the full action of 
the lungs and heart, and the patient is unable to lie down. 
The countenance indicates distress and anxiety. It is char- 
acterized by Mr. Wells as the "Facies Ovariana." The lips 



284 EATON ON DISEASES OF WOMEN. 

are thin, eyes sunken, tissues of the face seem atrophied, 
skin of face wrinkled. Emaciation of the neck and shoulders 
is also marked. (Edema of the extremities frequently com- 
plicates the case in this stage, and we sometimes have uraemia, 
resulting from the pressure of the tumor on the renal vessels. 

Differential Diagnosis. 

Ovarian tumors are liable to he incorrectly diagnosed 
from the fact of various ailments simulating them. It is 
common for the physician who has not a large experience 
in the examination of women to get embarrassed in making 
any examination of the female generative organs ; but he is 
especially liable to error of diagnosis in relation to the 
various tumors which affect these organs; and this is not 
to be commented on too severely, as errors of diagnosis in 
this regard have been made by the most noted gynaecologists. 
But the fact of errors of diagnosis having been made should 
stimulate investigation to that extent which may enable the 
future generation of physicians to become more expert than 
we are, or have been those who preceded us. 

The condition of pregnancy is one which sometimes com- 
plicates ovarian cystoma, and from which it is sometimes 
a little difficult to diagnose. Especially is this the case in 
the entire absence of menstruation, or its appearance in small 
amount at each monthly period. In the early months of the 
development of cystoma it is comparatively unimportant to 
make a clear, positive diagnosis, though it is more satisfac- 
tory to both physician and patient if we are able to do so. 
One of the most positive diagnostic points in pregnancy is 
the closure of the os uteri. If we find it closed, the os 
seeming as if cemented or glued shut, we may feel sure, 
in the absence of menstruation for three or four months, 
in connection with the enlargement of the uterus (apparently 
corresponding to the time of the suppression of the menstru- 
ation), that we have pregnancy in the case, and that the 



OVARIAN TUMORS. 285 

symptoms of pressure upon the rectum are clue to a retro- 
verted or retroflexed condition of the uterus. We find, on 
examination by the rectum, that the tumor feels dense, and 
that palpitation gives no evidence of fluctuation; and, upon 
pressing upwards on the tumor, we find the neck of the 
womb is moved downwards; while, if the tumor be ovarian, 
it might be moved without moving the uterus. The uterine 
sound should not be used unless we are positive that the 
patient is not pregnant. 

The gravid uterus, in the later months of gestation, is 
most frequently mistaken for ovarian tumor. I have had 
a case — a Mrs. S., of Peoria, Illinois — whose history showed 
a gradual development of the abdomen for over two years. 
She said the enlargement had commenced in the left iliac 
region, and steadily increased. She had the peculiar fades 
ovariana (mentioned by Wells), emaciation of shoulders, etc. 
Menstruation had been irregular, especially so for about 
seven months, being absent sometimes over two months, and 
scanty when it appeared. I diagnosed pregnancy, compli- 
cated with ovarian cystoma, contrary to seven or eight other 
physicians of excellent standing, who diagnosed ovarian cys- 
toma alone. The distension of the abdomen was enormous, 
and, the patient being very weak at the time I saw her, I 
did not feel it advisable to use anaesthesia to aid in the 
diagnosis; but I could distinguish the pulsation of the foetal 
heart, as I thought, though I could not detect motion of the 
child. I could feel a hard, irregular mass, occupying a part 
of the abdomen. The result proved the correctness of the 
diagnosis, as she was subsequently delivered of a dead 
foetus. After confinement, the distension of the abdomen 
remained, as well as the fluctuation, nearly the same as 
before delivery; and, after about two months, the patient 
died. I assisted in the necropsy, and found the uterus nor- 
mal. There was a large dermoid cyst of the left ovary, 
containing about twelve quarts of thick, opaque liquid, with 



286 EA TON ON DISEASES OF WOMEN. 

a large quantity of hair. There were also several small 
cysts. The right ovary also had some small cysts developed 
in it. The case was one calculated to mislead any one, and 
it was fortunate that no operative procedure was undertaken. 
The Placental Bruit. — The placental bruit, which is heard 
in pregnancy, may be present in fibroids of the uterus, or a 
sound which can not be distinguished from the placental 
bruit may be heard (I should say). Drs. Scanzoni and 
Churchill assert they have heard this sound in ovarian 
tumors; hence, it is not distinctive, and can not be relied 
upon in differential diagnosis. 

The Beating of the Fcetal Heart. — In using ausculta- 
tion over a suspected ovarian tumor, we should bear in mind 
that it is necessary, in order to avoid error, that we compare 
the rapidity of the supposed heart of the foetus with the 
pulse of the mother. For although the pulsations as heard 
in the abdomen may number 120 or 130 per minute, they 
may correspond with the pulse of the mother, and be simply 
the circulation of the blood in a fibrous tumor of the uterus. 

Time. — The time which has elapsed since the develop- 
ment of the first appearance of the tumor will" give some 
aid in diagnosing it from pregnancy, as the ovarian tumor 
will, as a rule, develop more slowly than the gravid uterus, 
with an occasional exception. It will usually take a year 
and a half or more to develop an ovarian cystoma to the 
size of the gravid uterus of seven months. 

Extra-uterine Pregnancy. — Some cases of extra-uterine 
pregnancy may be very hard to diagnose differentially from 
ovarian cystoma, as the uterus in both instances is about 
normal, and we may have menstruation continuing in both 
classes of cases. 

It is general that ovarian cystoma develops more slowly 
than extra-uterine pregnancy. In the extra-uterine preg- 
nancy, if it be tubal, there will generally be a rupture of 
the tube at about the third month, when a necropsy will 



OVARIAN TUMORS. 287 

probably be possible, and make the diagnosis clear. In 
ovarian and abdominal pregnancy, gestation may go on 
longer, and be more difficult of diagnosis, and we have a 
condition which simulates fibro-cystic growth of the uterus 
more clearly than ovarian cyst. Still, these cases bear 
some resemblance ,to ovarian cystoma. Generally, if the 
patient be placed under the influence of an anaesthetic we 
are able to make out the outline of the foetus within the 
cyst. There is generally more disturbance of the general 
health in extra-uterine gestation than in ovarian cystoma 
during the first months of its existence. 

Of course, the physician will, in these cases, never omit 
to listen for the pulsations of the foetal heart, which, if found, 
would materially clear up the diagnosis ; but if they are ab- 
sent, the case may still be one of extra - uterine gestation 
with a dead foetus. 

Enlarged Liver and Hypertrophy of the Spleen. — Car- 
cinoma of the liver or a collection of hydatids of the liver 
may be mistaken for ovarian tumor; also the enlarged spleen. 
But if we bear in mind these enlargements commence and 
are attached in the upper portion, instead of the lower part 
of the abdomen, together with the harder feel, in connection 
with the general health of the patient, and the history of 
the case, we will not be led into this error. 

Retro -Uterine Hematocele. — Retro-uterine hematocele 
may simulate ovarian cystoma of small size ; but it usually 
presses down between the vagina and rectum, much lower than 
cystoma, and is more diffused ; and, besides, the suddenness 
of the attack, occurring, as it usually does, at the menstrual 
period, taken in connection with the collapse, and shock to 
the nervous system occurring in hematocele, will be sufficient 
to differentiate it from cystoma, which comes on insidiously, 
without any serious disturbance of the general system at 
this stage. 

Fecal Tumors. — A retention of fecal matter in the rectum 



288 EATON ON DISEASES OF WOMEN. 

may in some measure simulate ovarian cystoma. Clearing the 
bowel with an enema of warm soap and water, followed by cool 
injections, will generally produce the desired effect, unless 
the impaction is situated above a retroverted uterus; in which 
case, if an effort be made to reinstate the uterus by means 
of the fingers or an instrument introduced into the rectum, 
the nature of the difficulty will become apparent. Constipa- 
tion would not be conclusive evidence of fecal tumor, though 
it be in connection with an enlargement in the posterior part 
of the vagina, as we have very usually constipation in ovarian 
cystoma, retro-version, and recto-vaginal hematocele. 

In some instances the tumor presses so much upon the 
nerves and blood vessels as to produce lameness and oedema 
of the lower extremities. Sometimes, though rarely, adhe- 
sions form in Douglas s cul-de-sac, which give the tumor the 
firm, immovable feel, very much like that which is felt in 
pelvic cellulitis, and we are to distinguish ovarian cystoma or 
fibroma, in these instances, from pelvic cellulitis, in that we 
have in pelvic cellulitis extreme tenderness on pressure, while 
in ovarian cystoma or fibroma the tenderness is only slight, 
even under considerable pressure. 

In the second stage of development, the urgent symp- 
toms, which sometimes characterize the first stage, are very 
much alleviated, as the tumor rises above the brim of the 
pelvis, the case is often looked upon and mentioned by the' 
physician and people as a recovery from inflammation of the 
womb — the term "inflammation of the womb" being intended 
to cover all conditions of inflammation in or about the female 
pelvic organs, excepting sometimes the bladder and rectum; 
just as the term " inflammation of the bowels" covers (in 
their careless way of expressing themselves), peritonitis, en- 
tries, peri-metritis, gastritis, hepatitis, etc., etc. But the 
error of the diagnosis is after a time apparent to one who 
understands the development of cystoma, for he knows that 
ovarian cystoma does not spring into existence in a day or 



OVARIAN TUMORS. 



289 



week, and develop into a tumor reaching near or quite to the 
umbilicus, which is about the period when the patient takes 
notice that she has a tumor, or perhaps she considers herself 
getting stout, or imagines that she is pregnant, although men- 
struation may continue, and be more than usually free. The 
patient is liable to believe the flow is an effort to miscarry 
or something abnormal, which does happen to some women 
while pregnant. They are sometimes so far misled as to 
imagine that they feel the motion of the foetus in utero, 
and the patient goes on till finally (as labor does not come 
on at the time she imagines it should) she becomes alarmed, 
and seeks medical advice, when it becomes necessary for the 
physician to decide the diagnosis of the case, and make out 
whether it is a case of pregnancy going over its usual time 
before delivery (which does quite often occur), or whether 
it is a case of cystoma or fibroma of the ovary, a fibroid of 
the uterus, a tumor of the broad ligament, abdominal ascites or 
a fibro-cystic tumor of the iderus. 

All of the following conditions have been mistaken for 
ovarian tumor, according to Prof Peaslee : * 



Pregnancy. 



Ascites. 

Normal. 

Extra-uterine. 

Molar and Hydatidi- 
form. 

Spurious. 
s With ovarian cyst. 
Encysted dropsy of peritonaeum. 
Tumor of broad ligament. 
Tumor of mesentery. 
Uterine fibroid, or fibro-cyst. 
Distended bladder. 
Retained menses. 



Excessive obesity. 
Physometra. 
Hsematometra. 
Hematocele. 
Tympanites. 
Renal tumor. 
Floating kidney. 
Splenic cyst. 
Hepatic cyst. 
Fecal tumor. 
Pelvic abscess. 
Retro-flexion. 



First, let us ascertain if there is evidence of a fluid within 
the abdominal walls, and if we are satisfied that there is, we 



Peaslee on "Ovarian Tumors," p. 122. 
19 



290 EATON ON DISEASES OE WOMEN. 

must proceed to find out whether the fluid is in the perito- 
naeum as a diffused liquid, or is contained within a sac. 

An excellent rule to act upon, in these cases, is to put the 
patient under the influence of an anaesthetic during the ex- 
amination. By this means the tension of the abdominal mus- 
cles is relaxed, and we have a, much better opportunity to 
discover -the nature of the disease, if any be present ; for it 
is not always that there is any tumor, even when it is sus- 
pected, and even when it has been so diagnosed by physicians 
of good ability, and even of renown. Dr. Simpson * quotes 
six cases, and Boinet f one case, where the abdomen was 
actually opened for the removal of an ovarian tumor, when it 
was found that tympanitis was the cause of the enlargement 
of the abdomen. Of course, some little care in percussing 
the abdomen would have caused the avoidance of such a mor- 
tification to the physician and danger to the patient. As the 
large ovarian tumor displaces the small intestines backwards 
and upwards, we find resonance only in the locality of the 
colon, or in the epigastric or hypochondriac regions, while there 
is dullness over the center of the abdomen. 

From Abdominal Ascites. — In abdominal ascites, the fluid, 
being contained within the peritonaeum, will gravitate to its 
lowest portion. Hence, when the patient is placed in the 
sitting position the fluid will gravitate to the lower part of 
the abdomen, and we will have greater fullness there than 
when the patient is reclining, more dullness on percussion 
over the lower part, and more resonance in the upper portion 
of the abdomen. Place the patient in the reclining position, 
on the back, and the abdomen flattens somewhat in abdominal 
ascites, while in ovarian cysts, or fibroma, w fibro-cy stoma, preg- 
nancy, cysts of the broad ligament, and fibroids of the uterus, 
the fullness and hardness of the center of the abdomen is main- 
tained about the same as when the patient is erect. 

In abdominal ascites there is some degree of resonance all 

* Fehr, p. 51. t Boinet, p. 200. 



OVARIAN TUMORS. 291 

over the abdomen, while in cystoma there is dullness over the 
center. In abdominal ascites we feel the fluctuation of the 
fluid more distinctly than in cystoma, where the fluid distends 
the sac, and gives to the tumor more the feel of a tense, hard 
substance. In abdominal ascites, if we place one extended 
palm on one side of the abdomen, and the other upon the 
other side, and give a sudden impulse with one hand, we feel 
the impulse in waves of motion, and not as a direct jar; and, 
by placing the ear to the abdomen, or near it, we may gener- 
ally hear the slush of the fluid within the peritoneal cavity, 
when it is of considerable amount. 

Some inquiry into the history of the development of the 
enlargement will aid much in the diagnosis. In abdominal 
ascites the enlargement is noticed in the lower portion of the 
abdomen, evenly distending it, while in single ovarian cystoma 
we learn that the enlargement was first noticed more to one 
side. If the patient has been troubled for a considerable time 
with renal, hepatic, or cardiac difficulties, we may be quite 
sure of having abdominal ascites in the case rather than ova- 
rian cystoma; while, on the other hand, if the history of the 
patient shows attacks of inflammation in the pelvis, disor- 
dered menstruation, with the discovery of the tumor first in 
the iliac region, we may conclude, w T ith considerable certainty, 
that the case is one of ovarian cystoma. 

Fibro-cystic Tumor of the Uterus. — The fibro-cystic 
tumor of the uterus develops more prominently in the hypo- 
gastric region at first, and simulates the impregnated uterus 
in its size and location much more than it does ovarian 
cystoma. 

Hydatids of the Omentum. — Hydatids of the omentum, 
though of extremely rare occurrence, are liable to be mis- 
taken for ovarian cystoma, when fully developed. It may 
be impossible to positively diagnose the difference between 
these diseases in some cases. If we bear in mind that hy- 
datids of the omentum commence well up in the abdomen 



292 EATON ON DISEASES OF WOMEN. 

(and they are usually discovered there), and enlarge down- 
ward, while in ovarian tumors they commence in the lower 
part, and increase upwards, we have a good point in differ- 
ential diagnosis. In some instances, where no adhesions 
have taken place, we are able to push the mass upwards, 
and determine that the attachments are not below and not 
adherent to the ovary or uterus. 

From Uterine Fibroids. — Uterine fibroids have been fre- 
quently mistaken for ovarian cystoma. It is quite impor- 
tant that this error does not occur, as an operation which 
might be advisable in ovarian cystoma might be very im- 
prudent in uterine fibroids. The fibroid tumor of the uterus 
is more dense, solid, rough, and nodulated, while the ovarian 
cyst is smooth. In ovarian cystoma the uterus is little 
affected, while in uterine fibroma we find it enlarged; hence, 
the uterine sound is an important aid in the differential diag- 
nosis of ovarian cystoma from uterine fibroids. In the case 
of the intra-mural fibrous tumor of the uterus the uterine 
sound may be passed seven or eight inches within the os. 
When we can do this we may be quite sure we have a case 
of an intra-uterine growth, and not ovarian disease. 

Carcinoma of the Fundus Uteri. — In Carcinoma of the 
fundus uteri we have the constitutional symptoms of cancer, 
with emaciation and fetid discharges, and the tumor does not 
reach great size before destroying life, so we are in no great 
danger of confounding it with ovarian tumors. 

Diagnosis from Floating Kidney. — Boinet* mentions four 
cases where floating kidneys have been mistaken for ovarian 
cystoma. The following facts are of importance : 

1. It is a very rare condition; much more so than is 
sometimes assumed, as we may infer from the fact that it is 
so seldom found after death. 

2. The assertion by writers that it occurs much more 
frequently in women than in men probably rests on the 

*Peaslee, p. 129. Boinet, p. 205. 



OVARIAN TUMORS. 293 

fact that a small ovarian tumor is frequently mistaken for 
it, and the diagnosis is not confirmed by post-mortem exam- 
inations. 

3. It is doubtless congenital. It is tender on pressure, 
and sometimes nausea is thus produced. It is movable, and 
has the peculiar shape of the kidney easily made out unless, 
as sometimes occurs, the hilum looks backwards. It can 
easily be lifted up out of the pelvis, is permanently the size 
of the kidney, and produces no symptoms. It may, how- 
ever, undergo cystic degeneration, when the diagnosis is more 
difficult. 

Dropsy of the Cavity of the Uterus. — Dropsy of the 
uterus resulting from a cancroid tumor of the fundus some- 
times occurs, and simulates ovarian cystoma. Dr. Simpson* 
reports a case of this kind. If the tumor has existed too 
long to suspect pregnancy, we should pass the uterine sound 
(for in the event of its being pregnancy with a cessation of 
its development from partial separation of the placenta it is 
unimportant to have the product remain), when we will dis- 
cover that there is a fluid within a sac within the uterine 
cavity. It may be punctured with a canula and the fluid 
evacuated, and such further treatment used as the case 
demands. 

Dropsy of the Amnion. — This results, in some cases, from 
causes which we are at present unable to explain. The dis- 
tension in these cases is sometimes enormous, and may be 
mistaken for ovarian tumor. There is usually complete sup- 
pression of menstruation for several months, and we feel 
distinct fluctuation in the tumor. The patient, though im- 
mensely large, has felt no movements of a foetus, and we can 
detect no foetus, or only a small one in the abdomen. Labor 
pains come on at the completion of the full term of gestation, 
however, when the nature of the difficulty is proven. In nil 
doubtful cases of suspected ovarian cystoma, it is best to wait 

* Simpson on ''Diseases of Women," p. 431. 



294 EATON ON DISEASES OF WOMEN. 

until nine or ten months have elapsed before being too sure 
of the diagnosis, especially when the menstruation is arrested. 

Retention of the Menstrual Fluid within the Uterine 
Cavity. — Cases of this kind, caused from occlusion of the 
neck of the womb or the external os, sometimes occur. They 
closely resemble in their history and symptoms dropsy of the 
amnion, and as we would not use the uterine sound unless 
fully convinced of the impossibility of pregnancy, we might 
be obliged to wait till the element of time helped to decide 
the case, unless the general health of the patient made some 
action on our part imperative. These enlargements of the 
uterus from dropsical conditions and retention of menstrual 
fluid may cause many of the ordinary symptoms of preg- 
nancy. There may be the morning sickness, enlargement of 
the breasts, disgust at the smell of food, etc., so that we have 
to be careful regarding these symptoms. 

Single Cyst of the Uterus. — I have seen in three in- 
stances a large single cyst in the uterus. These cases do not 
vary so much as to be important from large hydatid masses 
which are formed in some women. (Ten thousand of these 
small cysts have been delivered from a single patient.) In 
the case of a single cyst of the uterus we have the enlarge- 
ment of the uterus, as in pregnancy, with the ordinary symp- 
toms of polypi of the uterus ; still such a case might be mis- 
taken for ovarian cystoma. There is, however, no excuse for 
the error to continue to the extent of adopting operative pro- 
ceedings for the removal of ovarian tumor; for if we wait 
several months we will be convinced whether it is, or is not 
pregnancy, and if not, we may proceed to examine with the 
uterine sound, when we will ascertain the nature of the dif- 
ficulty, for very likely w T e will rupture the sac in making the 
exploration, as happened to me in one case which had been 
developing for over two years. I dilated the os with sponge 
tents, and freely cauterized the interior of the cavity of the 
body of the uterus with Arg. nit. The membranes of the 



OVARIAN TUMORS. 295 

sac were expelled, but no fibrous, foetal, or placental forma- 
tion. All these patients have remained without relapse, one 
now going on seventeen years, the others four and six years, 
respectively. 

Distended Bladder. — The physician who is very careless 
will be the only one likely to mistake this condition for ova- 
rian cystoma, and this mistake is most likely to be made by 
one wishing to be especially expert and show off his wisdom 
for the benefit of spectators. We generally find these cases 
will inform the physician that they are troubled with inconti- 
nence of urine, that it constantly dribbles away. Now this 
symptom, to the experienced physician, will at once cause 
him to suspect retention of urine, and he will at once use the 
catheter, which will clear up the diagnosis as if by magic. 
The length of time, also, which has elapsed since the disten- 
sion of the abdomen has existed will, in case of distension 
of the bladder, be found to be generally but a few days, 
while in ovarian cystoma it has been observed for months 
or years. 

Pelvic Abscess.- — In pelvic abscess the history of the case 
will show a preceding stage of active inflammation; while 
we have in cystoma no such stage. In pelvic abscess the 
duration of the difficulty is much shorter; for, if an abscess 
forms in the pelvis, the pent up matter seeks an outlet, and 
there will be observed tenderness at the point where the 
abscess is tending to find exit. In physometra, which con- 
sists of a collection of air or gas within the uterine cavity, 
sometimes of sufficient amount to cause quite a tumor above 
the pubis, we may discover its nature through percussion 
over the tumor, which will be so resonant as to indicate 
its nature. If we are in any doubt, pass a male gum cath- 
eter into the uterus, and make some pressure on the fundus 
of the uterus, and expel the air, when the tumor will dis- 
appear, and show that there can be no ovarian tumor in the 
case. 



296 



EATON ON DISEASES OF WOMEN. 



COMPARATIVE DIFFERENTIAL DIAGNOSIS OF OVARIAN CYSTS FROM UTER- 
INE FIBROID IN THIRD STAGE. 



Ovarian Cyst. 

1. More rapid growth. 

2. Expression of countenance dis- 

tinctive. 

3. Abdomen symmetrical. 

4. Abdominal veins enlarged. 

5. Kidneys inactive. 

6. General health impaired. 

7. Countenance pale. 

8. Frequently amenorrhea. 

9. Fluctuation distinct. 

10. Uterus normal. 

11. No tenderness. 



Uterine Fibroid. 

1. Slow growth. 

2. Natural expression of counte- 

nance. 

3. Not so much so. 

4. Not enlarged. 

5. Kidneys active. 

6. Not impaired. 

7. Dark. 

8. Menorrhagia. 

9. Rather elastic than fluctuating. 

10. Uterus elongated. 

11. Somewhat tender. 



COMPARATIVE DIFFERENTIAL DIAGNOSIS OF OVARIAN CYSTS FROM UTER- 
INE FIBRO-CYSTS IN THIRD STAGE. 

Uterine Fibro-cysts. 
No emaciation. 



Ovarian Cysts. 

1. Emaciation. 

2. Umbilicus prominent. 

3. Abdominal veins enlarged. 

4. Expression characteristic. 

5. Cyst wall very vascular. 



of 



6. Tumor moved independent 

uterus. 

7. Fluid light in cysts which have 

not been tapped — albuminous. 

8. Uterine cavity not generally 

elongated. 

9. Not tender on pressure. 



1. 

2. Umbilicus not prominent. 

3. Abdominal veins not enlarged. 

4. Expression normal. 

5. Cyst wall not very vascular — 

light color. 
Uterus moves with tumor. 



6. 



8. 



Fluid yellow or dark brown — 

coagulates. 
Uterine cavity generally elon- 



9. Tender on pressure. 



Diagnosis of Adhesions. 

The question whether or not the ovarian or uterine tumor 
has formed extensive adhesions is often of much importance ; 
for, if we feel sure no very extensive adhesions are present, 
we may advise operative procedure, when we might not if 
we were sure they existed; for the more extensive the 
adhesions the more clanger there is in the operation for the 



OVARIAN TUMORS. 297 

removal of an ovarian tumor, other things being equal. Dr. 
Peaslee, in his work on ovarian tumors, has given us some 
excellent suggestions on this point, which I will take the 
liberty to reproduce, although these hints apply to the 
adhesions in the anterior part of the abdomen, and at present 
we have no way of determining whether or not there are 
adhesions in the posterior part. If pregnancy be present as 
a complication we have more reason to expect adhesions than 
otherwise. The existence of adhesions may be inferred from 
the following conditions : 

"1. If the relations of the upper extremity of the tumors 
are not changed by deep inspiration. 

"2. If it is absolutely immovable. 

"3. If the abdominal walls can not be moved independ- 
ently of it. 

"4. If its position be not changed by tapping; sometimes, 
after tapping, adhesions may be felt. 

"5. If the tumor be a polycyst, and ascites do not co-exist. 

"6. If signs of inflammation have existed. 

" 7. If the fluid obtained by the first tapping is brownish, 
or of a darker color. 

"8. If the lower extremity of the tumor remains low in 
the pelvis, while the uterus is, at the same time, elevated. 

"9. If pregnancy has existed since the commencement of 
the growth of the cyst. (Dr. Keith.) 

"10. If the uterus is in front of the cyst in the third 
stage, even if the cyst is not felt per vaginam in the pelvis." 

SYMPTOMS WHICH INDICATE NO ADHESIONS OF THE CYST, OR ONLY 
SLIGHT, IF ANY. 

"1. If the tumor falls an inch or more during a full in- 
spiration, or if the muscles are seen' gliding over it. 

"2. If it can be moved freely up and down. 

"3. If the abdominal wall can be gathered up over the 
tumor, and made to glide from side to side freely. 



298 EATON ON DISEASES OF WOMEN. 

" 4. If the cyst falls down in a mass towards the pelvis 
after tapping. 

" 5. If ascites co-exist with the tumor. 

"6. Oligocysts and Monocysts are less liable to adhesions, 
but a large Monocyst generally has some adhesions to the 
omentum. 

" 7. If the tumor has grown very rapidly, and is not 
polycystic. 

"8. If the tumor is a dermoid cyst. 

"9. If no symptoms of inflammation have been observed." 

Hydrops Folliculorum or Vesiculorum. — This is the sim- 
plest form of ovarian cysts, and is comparatively unimpor- 
tant, as they seldom attain to any considerable size. They 
consist of vesicles attached to the ovary, and are seldom 
discovered before death. 

Cystoma Ovarii are divided into the monocysts, poly- 
cysts, oligocysts, and struma. The struma is a cysto-colloid 
degeneration of both ovaries, sometimes reaching the size 
of a man's fist, or larger, in their entirety; made up of 
numberless cysts, from the size of a millet-seed to that of a 
chestnut. The outer sac, or general capsule, is' smooth. 
They are extremely rare, and are of little importance, as 
they never attain to any considerable size, and the only 
effect produced is to cause sterility, or produce some symp- 
toms of weight in the pelvis, which are hardly explainable ; 
and, on rectal examination, and sometimes without, are dis- 
covered to be caused from an enlargement of the ovary, and 
this is supposed to be simple hypertrophy of these organs, 
till death results from some other cause, and a post mortem 
reveals the real difficulty. 

Oligocysts, or Monocysts. — These terms signify the single 
large cyst. It may contain compartments or division walls 
apparently showing the cyst to be composed of several smaller 
cysts; but, upon opening one, it is found that the fluid in the 
others is also evacuated, showing a free communication be- 



OVARIAN TUMORS. 



299 



tween them. These division walls are caused from a collasping 
of the walls of the cyst after tapping, and, from some adhe- 
sive, inflammatory action; becoming adherent in patches, so 
as to give somewhat the appearance of a polycystic tumor. 
The polycyst does not become a monocyst, as might appear pos- 
sible ; but this occurs from the oligocyst developing within it 
papillary vegetations, which are thrown out like a cauliflower, 
which finally adhere to each other, and make division walls in 
this way. The unilocular cyst, monocyst, or oligocyst, occurs 
only about one-fourth as often as the polycyst, while the dermoid 
cyst is found in only one case in about fifty of ovarian growths. 
Ovarian Polycysts. — The polycystic ovarian tumor is the 
most common form of cystoma with which we have to con- 
tend. It is made up of several distinct cysts, of considerable 
size. They may number but two or twenty or more. If 
more than one they take the name polycystic. The fluid con- 
tained within the different cysts varies often. The opening 
of one cyst by tapping will often apparently produce little 
effect upon the size of the abdomen, though several quarts of 
fluid flow away, and the abdomen may feel about as tense as 
before. This is convincing proof of the polycystic nature of 
the tumor. 

Differential Diagnosis of the Xhree Forms of Cystoma Ovariana. 



MONOCYST, OR OLIGOCYST. 




POLYCIST. 




DERMOID CYST. 


1. Slower growth. 


1. 


Rapid growth. 


L. 


Slow growth. 


2. Uncommon. 


9 


Common. 


2. 


Eare. 


3. Health fails late in the 


o. 


Health fails early. 


3. 


Very late. 


disease. 










4. Tumor disappears after 


4. 


Does not disappear. 


4. 


Disappears only par- 


tapping. 








tially. 


5. Adhesions uncommon. 


5. 


Adhesions the rule. 


5. 


Common. 


6. Fluctuations distinct. 


6. 


Less distinct and cir- 
cumscribed. 


6. 


Less distinct. 


7. Contains epithelial 


7. 


Contains blood pig- 


7. 


Hairs pathognomonic. 


scales. 




ment. 







Ascites, with Ovarian Cyst. — The coexistence of ascites 
with ovarian tumor was formerly thought to indicate carci- 
noma of the ovary ; but that idea is not now entertained. 



300 EATON ON DISEASES OF WOMEN. 

Disease of the heart, liver, or kidney may tend to produce 
ascites, and especially is this likely to be the case where the 
(umor is of large size, and, from its pressure, interferes with 
the normal circulation in the blood-vessels of these organs. 
Sometimes the rupture of one of the cysts of a polycystic 
tumor may produce peritonitis; or peritonitis may result from 
other causes, and effusion of serous fluid into the peritonseal 
cavity may complicate a case of ovarian cystoma. It, of 
course, increases the gravity of the case. 

The Pedicle. — It is sometimes important to be able to 
determine the length of the pedicle of an ovarian tumor, as 
we may feel more free to operate in case of a long pedicle 
than a short one. The long pedicle is indicated if the index 
finger in the vagina can detect no part of the tumor, and if 
the uterus is freely movable independent of the tumor. The 
opposite symptoms will indicate the short pedicle. 

Fibrous Tumors of the Ovary. — These are very rare. 
Kiwisch notes but two cases; Peaslee only two; Klob one 
case; Scanzoni four. They are really hypertrophies of the 
ovarian stroma. They are usually of a size varying from an 
orange to a cocoa-nut. They can seldom require treatment. 

Enchondroma and Osteoma. — Of these varieties of solid 
ovarian tumors we will simply say, they are very rare, only 
two cases of enchondroma being on record, reported by 
Kiwisch, and are both doubtful. Osteoma consists of a deposit 
of bone in a fibroid. 

Carcinoma of the Ovaries. — This disease spares no period 
of life except childhood. Cancer usually affects both ovaries, 
and most frequently commences in the uterus, and affects 
the ovaries secondarily. As a primary affection of the ovary 
it is very rare. It sometimes attains to considerable size. 
Lebert gives a case where the the carcinoma weighed eleven 
pounds, and Dr. Brown, of New York, had a case in which 
the diseased mass weighed nineteen pounds. We have in 
connection with cancer of the ovaries the usual cancerous 



OVARIAN TUMORS. 301 

cachexia, as when it affects other parts or organs. The dis- 
ease may be hereditary or acquired. It will not call for 
ovariotomy, but may be removed in connection with extirpa- 
tion of the uterus entire. (See extirpation of uterus.) 

Papilloma of the Ovary are also very rare and unimpor- 
tant. They arise from the corpus luteum, and consist of 
small vascular, vilous, or sometimes fibrous bodies of the size 
of a pea, pedunculated. 

Cyst of the Broad Ligament. — Cyst of the broad liga- 
ment is of slow development, is most usual in young women, 
and is likely to be confounded with ovarian cystoma. A 
single cyst has been known to contain forty pounds of fluid. 
Boinet speaks of their development from 1. The areolar tissue 
of the broad ligament; 2. The parovarium; 3. The vessels 
of the pampiniform plexus. The cyst of the broad ligament 
occupies a position lower in the pelvis than ovarian cysts, 
and is more readily felt in making a vaginal examination. 
Tapping causes complete collapse of the tumor. 

Hydrosalpinx, or Dropsy of the Fallopian Tube. — Cases of 
enormous distension of the fallopian tube have been reported. 
Such cases, though very rare, are well calculated to be mis- 
taken for ovarian cyst. Peaslee reports cases where the tube 
contained 130 and 150 pounds of fluid respectively. De 
Haen reports a case where there were 32 pounds of fluid in 
the tube. The color of the fluid in these cases is very clear 
and limpid. Although I have not seen a case of hydrosalpinx, 
I fear some error in diagnosis has been allowed to be reported, 
for I do not see how the tube can be so enormously distended 
without causing rupture. I believe that in tubal pregnancy 
the development of the foetus never exceeds four months 
before producing rupture of the tube. I am inclined to the 
belief that these cases called dropsy of the fallopian tube 
are cysts developed exterior to the tube proper, but under 
the peritoneal covering of the tube. Dr. Farre* also doubts 

5 Page 36. 



302 EATON ON DISEASES OF WOMEN. 

the capacity of the tube to undergo such extreme distension. 
De Haen states that the tube itself, in his case, weighed 
seven pounds. I doubt that the "seven pounds of tube" was 
really the hypertrophied tube; but I am inclined to think 
it was like Dr. Peaslee's* case which he considers dropsy of 
the fallopian tube. He says of the autopsy, " There was no 
pedicle, and no trace of the left fallopian tube or left ovary." 
Now, has he not as good reason to say the tumor was ovar- 
ian as tubal? There was a cyst, and a fibrous mass, which 
included the ovary and fallopian tube. Doubtless the case 
was fungoid, complicated with ovarian cystoma. 

Fibro-cyst of the Uterus. — This disease has only re- 
cently been recognized. Only fourteen cases had been re- 
ported up to 1869. Their development is much slower than 
ovarian cysts. They may be interstitial, or sub-peritonseal. 
Fibro-cysts of the uterus occur only about one-fiftieth as often 
as ovarian cystoma. They may develop as cysts within, or 
attached to a uterine fibroid, or as cysts attached directly to 
the uterus. They may be single or multiple. The fluid in 
these cysts is spontaneously coagulable. 

Cysts op the Mesenteric Glands. — Serous cysts of the 
mesentery sometimes form, and are likely to be mistaken 
for fibro-cysts of the uterus or ovarian cysts. Their attach- 
ment will indicate their nature. 

Uterine Fibroma {Fibrous Tumors of the Uterus.) — 
These tumors grow from the surface of the uterus or within 
its substance, and are fibrous in their structure. They vary 
in size from an inch in diameter to one weighing one hun- 
dred pounds. They occur most frequently in the aged. 
Their structure is dense, dark, or grayish, and within the 
fibrous structure are often contained small cavities filled with 
earthy matter, pus, or blood. They are frequently peduncu- 
lated. One or more may exist in the same case. 

Intra-mural fibrous grotvths of the uterus and fibrous polypi, 

■■ Peaslee on ''Ovarian Tumors," p. 105. 



OVARIAN TUMORS. 303 

requiring different treatment, will be spoken of separately. They 
have been mistaken for ovarian cystoma. They are more 
dense and solid, however. In some instances it may be im- 
possible to diagnose them from fibro-cystic tumor of the 
ovary. They never reach enormous size. 

Prognosis. 

The probable result of ovarian tumors, if left without 
treatment, is dubious as regards ovarian cystoma, for nearly 
all prove fatal in from one to four years — generally in about 
two years. As regards the solid tumors of the ovary (w T ith 
the exception of cancer), they have a favorable prognosis 
without treatment, even if of considerable size. There is 
occasionally an exceptional case where the patient continues 
for many years to live and carry about an ovarian cyst (sup- 
posed to be), and finally dies of some other disease ; but these 
cases are so rare as to be almost unworthy of mention. 
Medical treatment has, in a few instances, been reported as 
curing the disease. Boinet reports one and Professor J. D. 
Miller, of Chicago, three cases cured after prolonged treat- 
ment with Bromide and Iodide of Potassium. All agree, 
however, that medical treatment is in most cases useless. 

Dermoid cysts continue for a longer period without caus- 
ing death than the other forms of ovarian tumors. After 
suitable treatment a large per cent of all forms of ovarian 
tumors recover. 

Treatment. 

Remedies have generally been considered about useless, 
although my own experience has shown (see cases reported 
under treatment of ovaritis) that enlargements of the ovary do 
diminish, and sometimes disappear, from the use of remedies. 

It has been held, also, that ovariotomy was the only 
relief, and this idea is entertained by many prominent mem- 
bers of the profession to-day. Ovariotomy, 'tis true, has 
been very successful in skillful hands, but it is a serious 



304 EATON ON DISEASES OF WOMEN. 

operation at best, and we are glad to be able to show that in 
very many cases it is not needed, and that Iodine injections 
have cured ninety-three per cent of ivell selected cases, and about 
sixty-three per cent of cases taken at random, poly cysts included. 
Harm seems to have resulted in but six instances, though 
I have collected three hundred and eleven cases operated on 
by different gynaecologists in this country, Germany, France, 
and England. M. Boinet has done more than any other 
man to demonstrate the great advantage of this treatment. 
Out of these three hundred and eleven cases collected I find 
reported cures in one hundred and ninety-seven cases, or 
about sixty-three per cent, including favorable and unfavor- 
able cases. 

It strikes me this is good enough to justify a strong 
sentiment in favor of this method of treatment of ovarian 
cystoma ; besides, it is shown, from the reports of these 
cases, that, in the event that this treatment is unsuccessful, 
the patient is in nearly as good a condition for ovariotomy 
as without it. Peaslee * asserts they are in as good condition. 
I can not say as much. I will say, however, that I think 
that the injury produced by tapping and injecting Iodine is 
not so great as to deter us from attempting a cure in this 
way in all cases which are clearly monocystic. The punc- 
ture or punctures made in tapping may, and often do, cause 
adhesions, at these points, between the peritonaeum and sac 
(not always, however) ; and, in so much as they do produce 
adhesions, they in so far complicate ovariotomy, in case of 
failure of the injection to cure the case and ovariotomy 
becoming necessary. 

We should also bear in mind that the operation of tap- 
ping and injecting the sac is not free from danger, although 
Boinet had no unpleasant result in a single instance, out of 
ninety-one selected cases, producing sixty-one cures; and 
I am sure I have had no unpleasant results following tapping 

* Peaslee, p. 209. 



OVARIAN TUMORS. 305 

and injection with Iodine in a single instance, although I 
have treated but seventeen cases in this way, with recoveries 
in twelve out of the seventeen. Two died without ovariot- 
omy, one with it performed ; two recovered after ovariotomy. 
Of the twelve cases recovered, three were diagnosed poly- 
cystic by myself and others; the other nine were either 
monocystic or cyst of broad ligament. (I do not claim it is 
always that we can positively diagnose the difference. The 
weight of evidence, however, was that they were ovarian.) 
The polycysts required from seven to fifteen injections each, 
while the others required only one injection in four cases, 
and from three to five in the others. On the other hand, 
some physicians have had a sad experience in tapping ova- 
rian cysts. 

In Germany and England, out of two hundred and twenty- 
five first tappings, forty-eight died, or about twenty-two per 
cent. Dr. Meigs, of Philadelphia, states that nearly one-half 
of the first tappings of ovarian tumors which he had wit- 
nessed had proved fatal. Dr. Peaslee * says that " I learn from 
several of the most experienced ovariotomists of this and 
other countries that they do not consider tapping an ovarian 
cyst a dangerous operation." 

Here is a conflict of testimony. Can we ascertain why 
it is so harmless with one and so destructive with another? 
Without casting any reflections upon those who have been 
unfortunate in their cases (for misfortune comes to us all in 
some shape), let us inquire from what causes a patient is 
likely to die in case of tapping of the sac, in case of ovarian 
cystoma. 1st. She might die from peritonitis; 2d. From 
hemorrhage; 3d. From shock. Knowing the danger of peri- 
tonitis, the operator should use every means possible to avoid 
accidental cold after the operation, and see to it that the 
system is in as good condition as possible before the oper- 
ation. 

* Peaslee, p. 197. 
20 



306 EA TON ON DISEASES OF WOMEN. 

The danger from hemorrhage is greater in poly cysts than 
in monocysts, as the walls of the cysts are more vascular; 
and there is more danger from this source, in operating per 
vaginam, than through the abdominal walls. The operation 
should not he attempted through the vagina unless the tumor 
can he clearly felt fluctuating there. 

As to danger from shock, it is to be avoided by attention 
to the maintenance of pressure, as I will mention presently 
in describing the operation. 

I can not rid myself of the idea that, possibly, want of 
attention to some of these points may have caused some 
of these fatal cases, though I must acknowledge that bad 
results may sometimes follow ordinarily simple operations, 
even when the greatest care is exercised, not only in tapping, 
but in any operation in surgery. 

Strength of Iodine Solution to be Used. — A Solution of 
Iodine made with'Bi of Iodine res. and 3i Potass, iodide to the 
si of water, is the most desirable form and strength to be 
used, although in some instances this solution, diluted with 
water one-half, is sufficiently strong. The use of ordinary 
Tr. Iodine is, to my mind, open to some serious objection. If 
the sac has not been completely emptied before the injection 
is used, the fluid in the sac might so much dilute the Tr. as 
to allow of the deposit of the solid Iodine on the walls of the 
sac, which might irritate them too much at the points where 
the Iodine is deposited, and cause active inflammation. Dr. 
Byford's suggestion to use twenty grs. of Iodine with forty grs. 
lod. potass, to the ounce of water is open to the same objec- 
tion, as it requires three grs. of Iodide of Potassium to hold 
one gr. of Iodine in solution. The Tr. Iodine compositus I 
much prefer to the ordinary Tr. The temperature of the 
injection should be not too low nor too high, from 80° to 85° 
being the best. 

In making the puncture, care must be exercised to insert 
the trocar at a point where the tumor presses directly against 



OVARIAN TUMORS. 307 

the abdominal walls, and, if there be adhesion between the 
sac and abdominal walls, all the better. Percussion should 
always be made over the point we desire to puncture. If res- 
onant, avoid that point, as resonance will indicate that some 
part of the intestines intervene between the tumor and the 
abdominal wall. A point midway between the umbilicus and 
pubis, in the median line, is usually the most desirable place 
for puncture, although other points may be selected in some 
instances. I prefer not to make an incision in the skin before 
inserting the trocar, as without it we get a better closure of 
the skin over the puncture. 

The patient may sit in a semi-inclined position, or lie upon 
the side. There should be a free circulation of pure air in 
the room ; and the abdomen must be compressed steadily. 
This is best accomplished with a piece of muslin two and a 
half yards long and about eighteen inches in width, torn down 
at both ends into strips about four inches wide, like a many- 
tailed bandage, leaving about two feet of the center untorn. 
This should be passed around the body, and the strips inter- 
locked, and gentle tension should be made by an assistant on 
either side of the patient. This keeps up the pressure upon 
the abdominal organs, and prevents the collapse which might 
otherwise follow the sudden withdrawal of a large amount of 
fluid from the abdomen. 

In case the cyst can be reached per vaginam, and is felt as 
a fluctuating tumor there, it is better to puncture and inject 
in this locality. 

It has been suggested that the sac be washed out with 
warm water. This I do not consider necessary ; and, as it 
prolongs the operation, it is, in that much at least, objec- 
tionable. 

The quantity of fluid injected should be at least eight 
ounces, that it may come in contact with the entire internal 
surface of the sac. This should be aided, also, by turning 
the patient from side to side, while all the Iodine is in the 



3 ; EA TON OX DISEASES OF WOMEN. 

3yst and the compre- ; is still maintained. After allowing 
the injection to remain about five minutes, we may permit it 
to flow a •-.:'. :;. if the puncture is made in the vagina, the 

canula may remain and be held in position by the introduction 
of a good-sized sj rage into the vagina, so as to press upon 
the canula. This should be removed, cleansed, and re- 
r a new one substitute . every twelve hours for two 
or three day- when the s uld be removed. In punc- 

turing through the abdominal walls I would not allow the 
canula to remain, but remove it at once. The instant the in- 
jection t -ed to flow away, place a piece of adhesive plaster 
>ver the puncture, and pin a bandage tightly about the abdo- 
men : maintain pressure. 

Tsz :z iez TrM-KLAsnc Tube. — It is recommended, 
B md Simpson, that a gum-clastic e e passed through 

the canula. when a rasidei J>le part of the fluid had been 
evacuated, the canula withdrawn, and that the injection be 

le through the tube. I object to this on the ground that 
the elastic tube must be smaller than the canula in order that 
it . i be inserted, nd, xrasequen ly, the puncture into the 
be ) rgei than the tube, and will allow the escape 
of the fluid or injection into the perit: - spec ially 

the puncture . de through the abdominal walls. In case 
_ vagina, there is not the same objec- 

tion, as it is :he most dependent portion of the sac ; but even 
here we get alon_ better with :be canula alone, as It is firmly 
_ sped by the tissues Through which it passes, and is retained 
more easily than a smaller tube could be. 

E.i:in: Injecttohs. — In case the cyst should refill, and 
— r :-el sure ::v.::: : - ::z:<z: :y-~ : . :■. "'r =:: 

the operation as before, osing stronger injection the sec- 
.. 1 time. 

W:yz as .-.:: Iv:z ;::;::. — V.'ine has been -ed as an injec- 
tion into ovarian cysts; with such poor results, however, as 
a \:y its rejec tion for this purj : se. 



OVARIAN TUMORS. 309 

Modus Operandi of Iodine Injections. — Iodine seems to 
possess the property of causing adhesive inflammation, and not 
producing suppuration, unless it is used in such a way as to 
be escharotic. By adhesive inflammation we mean that when 
the Iodine is injected into the ovarian cyst it produces such 
an irritation as to cause enlargement of the mucous follicles 
of the sac. which spring up like granulations upon an inflamed 
conjunctiva, and if these are brought into co-aptation. adhe- 
sion results, and a consequent obliteration of the sac is in- 
duced, as in hydrocele when Iodine is injected in that disease. 

Iodine Injections into Ovarian Cysts not Painful. — 
There is no call for placing the patient under an anaesthetic 
for the operation of tapping and injecting a Sola, of Iodine. 
Boinet, with the skill which his large experience has given, 
says ; 'no pain is experienced when the injection is thrown 
into an ovarian sac" (he has performed the operation over one 
thousand times) ; but if it escapes into the peritonoeal cavity 
it produces great pain and severe peritonitis. 

Electrolysis. — Electricity has proven a curative agent in 
the hand of Fieber.* and he reports a striking case of cure 
of ovarian cyst by this treatment, and his report is corrobo- 
rated by C. Braun and reported by Schroeder.f Here is a 
wide and inviting field open for investigation and experiment. 
At present we can say nothing against the treatment, and 
only this much for it. 

Formation of a Permanent Opening into the Cyst. — In 
1836 Ledran made an incision into an ovarian cyst, and kept 
it open with pledgets of lint and a canula of sheet-lead for 
five months, and the patient recovered. Another case treated 
the same way continued to discharge from the artificial open- 
ing thus made for upwards of two years ; but finally recovered. 
In 1S24 Recamier proposed to cause adhesion of the cyst 
to the abdominal wall by the application of Caustic potassa.imd 

-Wien Med. Pr. 1871. No. 15. 

tZiemssen's Cyclopaedia. Vol. X, page 404. 



310 EATON ON DISEASES OF WOMEN. 

then make the incision, as Led ran had done. Mr. Bryant, of 
St. Thomas's Hospital, reports two cases treated successfully 
in this manner. This method has, at the present day, no ad- 
herents, that I am aware of. 

The tapping of the cyst in the usual manner, leaving the 
canula or gum-elastic tube in the puncture (by which means 
the fluid in the sac is allowed to be discharged), and using 
injections of a Solution of Iodine, to excite adhesive inflam- 
mation, is the plan now in favor. Dr. E. Noeggerath,* of 
New York, tabulates fifty-three cases of operations of this 
kind, viz: 



CURED. 


DIED. 


DISEASE RETURNED. 


UNDECIDED. 


34 


14 


4 


1 



Dr. Noeggerath also recommends the evacuation of the cyst 
by means of a free incision through the vaginal wall posterior 
to the os uteri, and stitching the incised vaginal and cystic 
tissues back so as to cause a permanent opening, and wash- 
ing out the sac daily with antiseptic injections. This opera- 
tion he terms "ovariocentesis vaginalis" He reports five out 
of six cases successful, five of which were polycysts. 

Spontaneous Rupture of the Cyst. — Dr. Simpson has suc- 
ceeded, in one case, in curing his patient by rupturing the 
cyst, and allowing the fluid to pass into the cavity of the 
abdomen. He was encouraged to do this from the fact of 
some patients recovering after spontaneous or accidental rup- 
ture of the cyst (probably most of them were cyst of the 
broad ligament). Dr. Tilt has collated seventy cases of 
spontaneous rupture of the cyst, with forty recoveries, or 
over fifty-seven per cent. Before proceeding to rupture 
a cyst, it would be better to aspirate a part of it at least, and 
see if the fluid is clear, bland, and transparent in character. 
If so, we may have little fear of its producing peritonitis. 

*Peaslee, p. 220. 



OVARIAN TUMORS. 311 

If, on the contrary, it is a dark, thick fluid, we may expect 
its escape into the peritonaeum will produce serious, and 
probably fatal, results ; and, of course, the operation should 
not be attempted in this class of cases. I will frankly state 
that I do not see the advantage of this treatment over tap- 
ping and injecting a Solution of Iodine ; for it strikes me that 
it is better to evacuate the cyst by aspirating it than to 
allow it to drain off into the abdominal cavity. I think there 
can be little dispute on this point ; hence, we can not recom- 
mend rupturing the cyst in any instance. 



312 EATON ON DISEASES OF WOMEN. 



CHAPTER XXV. 

OVARIOTOMY. 

The removal of the diseased ovary or ovaries by surgical 
operation is termed ovariotomy . The diseased mass may be 
removed through the abdominal Avails or the vagina. This 
diseased mass, arising from, or connected with, the ovary, 
is found to be cystic, or fibrocystic, in ninety-five per cent of 
all cases of ovarian tumors. 

HISTORY OF OVARIOTOMY. 

To Dr. Ephraim M'Dowell, late of Danville, Kentucky, 
belongs the honor of having performed the first operation for 
ovariotomy. This he did in October, 1809. His first three 
cases were published in 1816. Two years after Dr. Chrys- 
mar, of Wurtemburg, performed the operation — the first 
which had been performed in Europe. His first was unsuc- 
cessful; the second, performed a year later, was successful. 
Dr. E. M'Dowell shared the responsibility of his first opera- 
tion with Dr. Jas. M'Dowell, his nephew, he making the first 
incision, though the balance of the operation was performed 
by Dr. E. M'Dowell, assisted by Dr. Jas. M'Dowell. The 
report of this first case was published in the Eclectic Reper- 
tory and Analytical Revieiv for October, 1816. The opera- 
tion was performed upon a Mrs. Crawford in 1809, who lived 
till 1841. 

The second successful ovariotomist in this country was 
Dr. Nathan Smith, of New Haven, who performed the oper- 
ation in Vermont, July 5, 1821, he not being aAvare of Dr. 
M'Dowell's operation at that time. His operation was also 
successful. 



OVARIOTOMY. 313 

Now, over one thousand operations for ovariotomy have 
been performed in the United States, with a record of recov- 
eries amounting to about seventy per cent. 

In France, the first operation for ovariotomy was per- 
formed by Dr. Woyerkowsky, in April, 1844. This case 
was also successful. In Russia, Sweden, Germany, France, 
Australia, Italy, and England, the operation is practiced as 
a standard operation; while in Ireland, it is seldom performed. 
In Belgium, Iodine injections are most extensively used. 

The operation has met with violent opposition in this coun- 
try and Europe, and it has been only within the last quarter 
of a century that the operation has been countenanced gener- 
ally. Of late years, the sentiment in its favor has been 
very strong in this country and Europe, with the exception 
of Belgium and Ireland. Skilled operators have reached 
an average of success in about seventy-eight per cent of 
their cases, while, if we include in our figures all the opera- 
tions recorded, the average per cent of recoveries drops to 
about fifty. At the present time there have been probably 
over five thousand ovariotomies performed in the world. 

As to precedence in the operation, there has been some 
dispute, some having claimed that Dr. M'Dowell was not 
the first to perforin the operation, Dr. Robert Houstoun, of 
Glasgow, having in 1701 made an incision into an ovarian 
cyst, and evacuated its contents; but he did not remove the 
cyst, and his operation could only be called "ovarian sec- 
tion." In 1782 Laumonier* operated on a case which has 
been claimed as one of ovariotomy. Koeberle and Boinet, 
however, assert that Laumonier's operation was not one of 
ovariotomy, but a case of dropsy of the fallopian tube, com- 
plicated with ovaritis. The ovary was as large as an egg. 

The ovaries were removed, however, in a healthy state 
hundreds of years before Dr. M'Doweli's operation. We are 

*"Histoire de la Societe Royale de Medecine," 1782, tome v. 



314 EATON ON DISEASES OF WOMEN. 

told by De Graaf* that a Hungarian sow gelder removed 
the ovaries from his daughter (being disgusted with her 
lewdness) more than two hundred years since; and it is a 
matter of history that certain kings of Lydia had the ovaries 
of women extirpated for their service or pleasure, using 
them instead of eunuchs as servants. Gyges hoped thereby 
to establish their perpetual youth. We have no record of 
the per cent of the success of the operation, and it could 
not be considered ovariotomy as now accepted, but rather 
spaying. 

OBJECTIONS TO OVARIOTOMY. 

It has been urged against ovariotomy that it was too 
dangerous an operation, that the statistics in its favor are 
unreliable, that palliative treatment by medicine or tapping 
might prolong life indefinitely, that even if the operation is 
successful in removing one ovary the other may become 
affected. To-day, these objections have little weight; the 
danger of the operation is yearly becoming less, owing to 
more skillful management. In fact, when we note the rough- 
ness of the operation, as detailed by Dr. M'Dowell, in his 
first cases, we are filled with wonder that either recovered. 

The delay of the operation till the disease was too far ad- 
vanced, and till the pressure upon the abdominal organs had 
too much disturbed the general health, has doubtless been 
the cause of some fatality. But now, that the operation is 
sanctioned by the best authority, it is not delayed as for- 
merly, and the care exercised to prevent peritonitis and 
secondary hemorrhage is such as to add largely to the suc- 
cess of the operation. 

The statistics, doubtless, are as correct in regard to this 
operation as any other. As to relief from medicines I believe 
but thirteen cases are on record where a cure is claimed from 

*De Mul "Organ Generat. tract. Nov. Cap. xiii." 



OVARIOTOMY. 315 

internal medication, and doubtless some of these cases were 
erroneously diagnosed. Not over five per cent of cases of tap- 
ping have proven curative. Tapping, with injections of Iodine, 
have proven very successful, it is true. According to sta- 
tistics laid before the French Academy of Medicine,* about 
three-fifths of the cases were cured by Iodine injections. 
Boinet had sixty-two cures and twenty-two failures, and six- 
teen deaths out of his first one hundred cases. He does not, 
however, attribute any death to the operation, for he says 
"the operation did not produce any unpleasant result in a 
single instance." Simple tapping seems to be very unpromis- 
ing of good results; but the injection of Iodine in connection 
with tapping offers a treatment full of promise, especially in 
monocysts. The operation of ovariotomy is, then, to be con- 
fined mainly to the removal of poly-cystic and dermoid cysts ; 
fibrous, and fibro-cystic tumors of the ovary. 

WHEN SHOULD THE OPERATION BE PERFORMED? 

Dr. Clay, Dr. Bryant, Drs. Black and I. B. Brown prefer 
to operate as early as possible, about as soon as the diag- 
nosis is made out; while Drs. Atlee, Bradford, Keith, Smith, 
and T. S. Wells, as well as Dr. E. R. Peaslee, speak in favor 
of waiting till the disease is well advanced, though not to the 
extent of very severe impairment of the general health. 
It is best to wait till we see evidences of serious danger to 
the patient if the tumor longer remains, for occasionally a 
case occurs where many years pass (sometimes two or more) 
without deranging the general health to any great extent, 
and it is not advisable to jeopardize the patient's life by 
an operation which, if left unperformed, might possibly 
have permitted the patient to live in the enjoyment of com- 
parative health for some time to come, while the operation 
might cut her life short at once. 

* Peaslee, page 267. 



316 EATON ON DISEASES OF WOMEN. 

CAUSES OF DEATH AFTER OVARIOTOMY. 

The result of one hundred and fifty cases of ovariotomy, 
collected by Dr. Peaslee, showed ninety-nine successful opera- 
tions and fifty-one deaths. The direct cause of death in 
these fifty-one cases he tabulates as follows : 

Peritonitis 12 or 23.53 percent. 

Septicemia 9 or 17.65 

Shock 7 or 13.72 

Exhaustion 7 or 13.72 

Shock and Septicaemia 1 or 1.96 

Hemorrhage 1 or 1.96 

Strangulation of intestines in womb lor 1.96 

Diarrhoea lor 1.96 

Erysipelas 1 or 1.96 

Tetanus 1 or 1.96 

Ulceration through bladder 1 or 1.96 

Unknown 9 or 17.64 

51 
These figures would be modified very much if we take in 
a larger scope. Thus, in two hundred and thirty-four cases 
of death from ovariotomy, occurring in Great Britain, Ger- 
many, France, and the United States, — 

96 were from peritonitis; 
33 from hemorrhage; 
15 from collapse; 
90 from all other causes. 

Total, 234 cases. 

AFTER OPENING THE ABDOMEN, WHEN SHOULD THE OPERATION BE 

ABANDONED ? 

Before commencing an operation, it is always well to be 
prepared for all the emergencies that may arise, as well as 
the complications with which we may meet. Surgeons of 
large experience have been mistaken in their diagnosis of 
ovarian tumors, as has been mentioned while speaking of dif- 
ferential diagnosis. In case the abdomen is opened, and it is 
then found that we have a solid tumor of the spleen, liver, 
mesentery, or kidney, it is best to close the incision imme- 



OVARIOTOMY. 317 

diately, and suspend the operation. If it be a cyst of the 
kidney, spleen, liver, or a uterine fibro-cyst, non-pedunculated, 
we may tap the cyst, inject a Solution of Iodine, and close the 
wound. In case of the uterine tumor having a, moderately- 
sized pedicle, we may proceed to remove it, if there are not 
very extensive adhesions. If the tumor prove to be cyst of 
the broad ligament, simple tapping is all that is required. It 
is but seldom necessary to abandon an operation on account 
of adhesions; for if the operation be abandoned the patient is 
liable to die from the result of the incision (about thirty per 
cent dying under these circumstances) very soon after the 
operation, while those who live, or rather recover from the 
operation, are left to die before long from the tumor. Hence, 
it is generally as well to proceed with the operation, even 
if the adhesions require ligature, although 70 per cent die if 
adhesions are so strong as to require ligature. 

PREPARATORY TREATMENT. 

Operators differ greatly upon this point. Some undertake 
the operation with little or no regard to the condition of the 
patient, while others attach much importance to the necessity 
for some preparatory treatment. We may lay down the gen- 
eral rule, however, that it is better that the digestive and 
assimilative process should be in as healthy a condition as 
possible at the time of the operation ; that the bowels be 
freely evacuated with soap-and-water enemne, and, in obstinate 
cases, with some saline waters ; that nourishing, easily di- 
gested food should be given for some time before the operation. 
Subnitrate of bismuth, given in three gr. doses every three 
hours, for twenty-four hours before the operation, is advisable 
in case there is much tympanites in any portion of the abdo- 
men. It is of considerable importance to secure free "action 
of the skin. The operation should not be attempted while 
the skin is hot and dry. In this condition it is better to give 
Aconite 3 X every three hours, till some slight perspiration is' 



318 EATON ON DISEASES OF WOMEN. 

established. The giving of Aeon, for three or four days pre- 
vious to the operation, in most cases, is a good practice, giving 
it at intervals of four to six hours. It has a great tendency 
to prevent inflammatory action. Dr. T. G. Thomas gives 
opium, in one gr. doses, for four days previous to the opera- 
tion, at intervals of six hours. This treatment has the objec- 
tion that the opium has a constipating effect upon the bowels 
just at a time when we desire their free evacuation. 

WHEN THE OPERATION IS IMPROPER. 

1. While the patient is in the enjoyment of good general 
health no operation should be advised. 

2. Not till tapping and injections of Solution of Iodine have 
demonstrated that these means are inadequate. 

3. When there is organic disease of the lungs, heart, 
liver, kidneys, or bowels, cancer of the breast, stomach, or 
other parts of the body. 

4. The operation should not be performed during the pre- 
valence of an epidemic of any kind in the immediate vicinity. 

5. When the tumor is evidently malignant. 

6. When the patient is so weak from any cause as to 
make it very doubtful whether or not she is able to with- 
stand the shock of the operation. 

PREPARATION NEEDFUL TO BE ATTENDED TO ON THE PART OF THE 
OPERATOR AND FRIENDS. 

1. The Time of the Year. — Both the hottest and coldest 
temperature should be avoided. The clear, moderately cool 
atmosphere is the best. 

2. Place. — The healthful suburb of a city is, perhaps, the 
most desirable, as the patient is then within easy calling dis- 
tance of the surgeon, while, if we operate in the country, we 
must trust the care of these cases to some assistant. Avoid 
operating in a large hospital, as the air can hardly be as pure 
here as in the small hospital or private house. 



OVARIOTOMY. 



319 



3. Temperature of the Room. — While the operation is 
progressing the temperature of the apartment should be main- 
tained at 78° or 80° ; but as soon as the incision is closed and 
dressings applied, the temperature should be lowered to 68° or 
70°. The apartment should be quiet, large, and capable of 
the best of ventilation. The spray apparatus (see Plate XI) 
is recommended, which throws a spray into the room, impreg- 
nated generally with a small amount of carbolic acid. This 
does well ; but, in case we have not the apparatus, a cup of 
water may be placed upon the stove, if the weather be cool 
and needing fire, and a tea- spoonful of Comp. tr. Iodine or Car- 
bol ac. added to it, that the vapor of Iodine or Acid may per- 
meate the air of the room. 

Suitable Dress. — The patient should be warmly dressed 
in flannel, with woolen stockings on the feet. 




Fig. No. 21.— Operating Table. 

Operating Table, Instruments, Etc. — A suitable operating 
table is convenient. It should be high enough, so that the 
operator will have to bend over the patient very little, 
or none at all. It should be six feet long and about two 



320 EATON ON DISEASES OF WOMEN. 

feet wide. It is a great convenience to have a little room 
on the table not fully occupied by the patient. The table 
should be covered with India-rubber cloth, placed over a folded 
quilt or pair of blankets, with hair pillow for the head. It is 
well to have the India-rubber cloth covered with a flannel 
blanket, so folded as to wrap around the lower limbs and keep 
them warm. 

The surgeon, before commencing the operation, will ob- 
serve that he is provided with eight or ten assorted sponges, 
well cleansed, and examined that they contain no small bits 
of shell or rough points. It is well that they be moistened 
with a weak solution of carbolic acid two days before they are 
needed. Three or four basins of water, both warm and cold, 
should be at hand ; and it is better that w T e use cistern-water, 
filtered, for this purpose, that by no means there may be sand 
or small, rough particles in the water, which might prove irri- 
tating. A small tub and bucket, with a dozen or more tow- 
els, two old sheets, some extra pieces of flannel and several 
pairs of flannel blankets, should be at hand. The bed upon 
which the patient is to remain should also be in the room, 
standing convenient to the operating table (though it x may be 
brought in afterwards, if the room is small). 

The instruments needed should be selected in an adjoining 
room (so as not to disturb the patient), and placed on a tray 
and covered with a towel before they are taken into the pres- 
ence of the patient. 
They should consist 
of three or four dif- 
ferent sized scalpels, 
dressing, dissecting, 
artery, and hooked 

Fig. No. 22— Spencer Wells' Trocar. r n 

forceps, one grooved 
director, straight and curved scissors, two or three tenacu- 
lums, two trocars (one being long and curved), chain ecraseur, 
one steel male sound, three or four strong retractors, one uter- 




OVARIOTOMY. 



321 




G.TIEMANW-CC, 



Fig. No. 23.— Dawson's Clamp Modified. 



ine sound, female catheter, eight or ten needles threaded with 

carbolized silk thread, 

and three or four 

threaded with silver 

wire ; also several 

pieces of saddler's silk 

for ligatures (waxed), 

some cat-gut string for the pedicle, and a clamp, in case it 

seemed best to use it. (See also Plate XV.) 

Extra pieces of rubber cloth, adhesive plaster, artificial 
serum, bottle of solution of Persulphate of Iron, and Chloro- 
form, or Sulph. Ether should also be in readiness. A little 
wine, brandy, or whisky should be at hand, as well as am- 
monia, a can or bag of oxygen gas, and a bottle of Nit. Amyle. 

THE METHOD OF PERFORMING OVARIOTOMY. 

The patient is now placed upon the operating table with 
only a, small pillow under the head. (Some authors have 
recommended a large pillow, or even two or three pillows, 
placing the patient in a semi-recumbent position, which is 
very objectionable on account of the anaesthetic, it being 
much more unsafe to use any anaesthetic while the patient is 
semi-recumbent than in the recumbent position.) Four assist- 
ants should be at hand, three of whom should be skilled 
surgeons, the other may be a student or nurse, Avho will be 
found useful to hand what is required, regulate the tempera- 
ture of the room, etc. 

The administration of the anaesthetic should be entrusted 
to none but a skilled and experienced surgeon, as very much 
depends upon its proper administration, and the operator and 
two assistants should feel that they are obliged to have no 
care about the anaesthetic. The physician giving the anaes- 
thetic should know when complete anaesthesia is required, 
and when it will do to allow it to be partial; when to use 

Ammonia or Oxygen to revive her, etc. 

21 



322 EA TON ON DISEASES OE WOMEN. 

The patient is now brought fully under the influence of 
the ancBsthetic, and every thing being in readiness the first 
incision should be made through the skin in the direct line 
of the linea alba, commencing a little below and a half inch 
to one side of the umbilicus, and extending downwards to 
within an inch of the pubis, in case we perform gastronomy, 
which is the usual operation, and is the necessary one, if 
the tumor is of any considerable size. 

After making the first incision with the scalpel, which 
may penetrate somewhat into the adipose tissue (if there is 
any), we pass the grooved director under successive layers 
of fascia and muscular tissue, and incise with the edge of the 
scalpel, away from the patient, till the peritonaeum is reached, 
when it should be seized with the hook forceps and an incis- 
ion made in it with a sharp pointed, straight scissors after 
the arrest of any hemorrhage. Into this cut made with the 
scissors I prefer to insert the index finger of the left hand, 
and explore for adhesions in the line I desire to incise the 
peritonaeum; and if I find adhesions make the incision to one 
side of them, if possible, using the finger so inserted as a 
director, making the incision (hrough the peritdnaeum in 
length to correspond to the external cut. We now bring the 
tumor into view by separating the lips of the incision. 

The next step is to explore for adhesions, and make out 
a clearer diagnosis of the tumor; then tap the cyst (if it 




Fig. No. 24. — Spencer Wells' Artery Forceps. 

be one) with Spencer Wells' trocar ; detach adhesions ; 
ligate the pedicle ; remove the tumor ; arrest the hemorrhage, 



OVARIOTOMY. 



323 



by torsion or ligation of the bleeding vessels; examine the 
other ovary, and remove it if required; cleanse the periton- 
eal cavity; close the incision; apply proper dressing; see the 
patient placed properly in bed, and returned to conscious- 
ness. It is sometimes best to tap the cyst, or cysts, if there 
be more than one of any size, before exploring much for adhe- 
sions, as it often is of so large a size as to be very difficult 
of examination before tapping. 

Before inserting the trocar place a small elastic band over 
the instrument, and have it strong enough to clasp it firmly ; 
then sieze the sac with a pair of hook forceps, draw it out 




Fig. No. 25. — Double Tenaculum Forceps. 

a little, and, after turning the patient well on the side, 
plunge in the trocar, and, as soon as some portion of the 
fluid has passed out, draw the sac up around the canula, 
sieze it with the hooks, draw it back, and slip over it the 
elastic band, so as to grasp the walls of the sac, and hold the 
canula firmly. In this manner no fluid from the sac need 
escape into the abdominal cavity. 

We now sieze the sac, and ascertain if our incision is 
large enough to easily extract the mass after evacuating the 
cysts. If not, then we may extend it upwards as high as 
necessary, using two fingers passed up between the tumor 
and the peritoneum, and making the cut through all the 
tissues at once. 

We now arrest any hemorrhage caused by this second 
incision, and proceed to find and divide any adhesions 



324 EATON ON DISEASES OF WOMEN. 

between the tumor and the surrounding parts, breaking off the 
adhesions with the fingers, if it can be clone without using 
very great force. If not, a small silk ligature may be ap- 
plied firmly, cut short, and left in the abdomen (or left long 
if near the incision). This is very generally necessary in 
case of the adhesion of the omentum; or we may cut out a 
piece of the sac, and leave it attached in the abdomen. 

If, on tapping the sac, we find its contents too thick to 
run out through the canula, we may, after enlarging the 
incision in the abdominal walls (to the greatest possible 
extent), turn the patient on the side, as for tapping the sac, 
and, lifting the tumor out of the abdominal cavity as much 
as possible, proceed to make a free incision into it, and turn 
out its contents. 

If it is of sufficient size so as to seriously interfere with 
getting at and tying the pedicle, after emptying one cyst in 
this manner, by free incision, and finding the tumor to be 
multilocular, it is best to divide the walls of the other cysts, 
so as to allow of the discharge of these other cysts, also, 
through this first one incised. 

The recommendation of some authors to immediately 
sponge out any fluid or blood which escapes into the abdom- 
inal cavity is a poor practice. It irritates the peritonaeum 
much more to keep wiping it out than it does to allow the 
fluid to remain till the tumor is separated from the pedicle, 
and have the whole cleansing performed at once; besides, the 
practice of frequent sponging delays the operation very 
materially, and is objectionable in this respect as well as on 
account of the irritation it is calculated to produce. Of 
course, in case we tear a blood-vessel, and torsion does not 
at once arrest the hemorrhage, we must stop and apply 
a fine silk ligature to the bleeding vessel, cutting it short, 
as before mentioned. 

In case we. find, after opening the abdomen, that we have 
a case of a considerable fibrous mass in connection with the 



OVARIOTOMY. 325 

cyst, we find advantage in passing the male sound all around 
the tumor to discover at what point and to what extent we 
have adhesions to contend with. If they are so extensive 
as to make it impossible to separate them and remove the 
mass, we may proceed to evacuate the cysts in the manner 
described; and, if the tumor, or rather the cyst wall, is not 
very vascular, we may ligate some parts of it, and cut it 
away, sponging out the remaining portion of the cysts with 
Comp. Tr. Iodine or Solution of Iodine. Carefully sponge out 
the cavity of the abdomen with warm water or warm artificial 
serum, to which a few drops of Carbolic acid has been added, 
and then close the incision as rapidly as possible. 

In case we find that the adhesions can be broken up, or 
are not very numerous which require ligation, we proceed 
to carefully divide all the attachments and lift the tumor out 
of the abdomen. 

We now examine the pedicle. If it is not larger than a 
man's finger, it may be ligated as a whole; while, if of 
greater size, a double ligature should be used, placing the 
ligature in either instance about an inch from the bulk of 
the tumor. This ligature for the pedicle must be strong cat- 
gut, whip cord, or extremely strong silk ligature (I prefer 
the catgut), tie it tightly in three knots so as to avoid the 
possibility of its slipping. (These ligatures, as Avell as all 
those used in the operation, should have a previous prepara- 
tion by being wet with a weak solution of carbolic acid.) The 
ends of the ligature may now be seized by an assistant, and 
the chain ecraseur thrown around the pedicle close to the 
tumor, so as to allow about an inch of pedicle beyond the 
ligature; screw down the ecraseur, and thereby divide the 
tumor from the pedicle. We should next sponge the end of 
the pedicle with warm, carbolized water, holding it out of 
the cavity of the abdomen if it can be done without using 
too much traction (which is to be avoided). 

After Ave see that the ligature is firm and that there is 



326 EATON ON DISEASES OE WOMEN. 

no oozing of fluids, we proceed to examine the other ovary, 
and, if found diseased, it should be at once removed by ligat- 
ing its attachment and removing it with the ecraseur as before. 
If not diseased, of course it should remain, as it may per- 
form its function well, and the patient by its aid may bear 
fruit thereafter, which would be impossible if both ovaries 
were removed. 

We now sponge carefully all the secretions from the ab- 
dominal cavity, cleansing the sponges in carbolized warm 
water or artificial serum of a temperature as high as 96° 
or 98°. 






Fig. No. 26. — Sims' Sponge Holder. 

When we are sure we have cleansed the peritoneal cav- 
ity of all blood or other foreign substances as carefully and 
with as much gentleness and dexterity as possible, and we 
ascertain there is no small twig of a blood-vessel lacerated, 
bleeding, and overlooked, we proceed to cut off the ligatures 
surrounding the pedicle within about an inch of the knot 
and drop the ligated pedicle gently into the abdomen and 
proceed to close the incision with interrupted suture of 
silver wire of good size, or tolerably stout silk thread (I 
much prefer the silver wire), have the needles threaded with 
long enough wire so that we have plenty of it, so as not to be 
inconvenienced on account of its shortness. The open-eyed 

needle is most convenient. 

The assistants should hold 

IT"^- 5 ^ the parts in apposition as 

Fig. No. 27.-Open-eyed Nee^e. ^yj ^ pogsible . the gtitcheS 

should be set back about one-half inch from the cut, and 
should dip down to, and include, the peritonaeum (this was 
not formerly done ; but it is now the more general practice) . 
The stitches should be placed at intervals of about three- 
fourths of an inch. The silver wire should be well twisted, 




OVARIOTOMY. 327 

cut off rather short, and bent down smoothly upon the ab- 
domen. 

After the sutures are adjusted, the intervals between the 
sutures should be covered with long strips of adhesive 
plaster reaching at least one-half around the body. Then 
apply other strips upon these, which need only be four or 
five inches long, and let them cover the sutures, so that the 
entire incision is hidden from view ; and, of course, atmos- 
pheric air is perfectly excluded if the adhesive plasters are 
properly adjusted (during the application of the plaster the 
anaesthetic should be entirely suspended). When we desire 
to examine the Avound we have only to raise one end of 
some of the short pieces of plaster, and when we desire to 
remove the sutures one of the short pieces of adhesive 
plaster may be raised, the suture cut and removed, and the 
adhesive plasters immediately replaced, one by one, till all 
are removed. The long pieces of plaster should remain for 
a week or more, and when removed should be replaced by 
others at once one by one. 

After applying the adhesive plaster in the manner de- 
scribed, a compress of flannel (about four thicknesses) should 
be applied over the abdomen, and a cotton roller or bandage 
applied around the body to support the abdomen and hold 
the compress evenly and tightly. 

The patient should be now placed in bed, and, on the 
return of consciousness, a powder of the 3 X of Nnx may be 
given. Unless full reaction sets in, it should be repeated 
every hour till it is established. Avoid stimulants and 
opiates. Then Aconite, given every three or four hours, 
should be administered, and, if pain is complained of, give 
Arnica in alternation. The thighs should be flexed to re- 
move tension from the abdominal muscles, and the limbs 
should be supported with pillows, and a rubber bag, filled 
with warm water, placed against the soles of the feet. 
Soups, porridge, thickened milk, custard, bread and milk, 



328 EATON ON DISEASES OF WOMEN. 

oat-meal gruel, etc., should constitute the diet for a week or 
more. No solid food should be allowed, and no applications 
should be made to the abdomen except those already men- 
tioned. Wetting the compress with water or Arnica is not 
necessary, and is calculated to loosen the adhesive plaster, 
and makes the patient more liable to take cold, and had 
better be avoided. 

DIFFERENT METHODS OF OPERATING. 

The incision which is now almost, if not quite, universally 
made near the median line in the linea alba, was formerly 
made obliquely at the side of the abdomen. This was the 
place of the incision made by Dr. M'DoAvell on his first 
operation, following a line in the direction of the fibers of 
the external oblique muscle. 

Treatment of tlie Pedicle. 

The various means used by operators to secure the pedicle 
are more diverse than is any other part of the operation. 

The pedicle is lied by some, and one or both ends of the 
ligature are brought out of the incision at its lower portion, 
leaving the pedicle in the abdomen. This practice has proven 
successful, but as it takes several weeks for the ligature to 
become separated, and in the mean time causes a, fistulous 
opening between the peritonseal cavity and the external 
atmosphere, giving rise to more or less of suppuration around 
the ligature, I prefer to cut the ligature short, and allow it 
to remain within the abdomen, and close the peritoneal cavity 
permanently and at once. 

Dr. Nathan Smith ligated each artery of the pedicle, 
separately cut the ligatures short, and returned the pedicle. 

Dr. Atlee crushed off the pedicle with an ecraseur, and 
returned the pedicle after cauterizing the end of the stump. 

Dr. I. B. Brown applies the actual cautery with red hot 
iron to the end of the pedicle, and replaces it in the abdomen. 



OVARIOTOMY. 329 

Twisting off the pedicle, using a clamp to hold it before 
it is severed with the scalpel, leaving a portion beyond the 
clamp an inch or more in length, then applying another 
clamp to this free portion, and while holding the lower clamp 
firmly twisting the other around like wringing a chicken's neck, 
till the pedicle is twisted off — this method has been practiced 
by Dr. G. H. B. M'Leod, of Glasgow. 

Torsion of the separate vessels of the pedicle has been 
successfully used by the late lamented Dr. G. D. Beebe,* of 
Chicago — eight out of ten cases treated in this manner hav- 
ing recovered. No hemorrhage occurred in either case. Tor- 
sion of the whole pedicle has succeeded in the hands of 
Mr. Jessup.f 

The clamp has been more generally used than any other 
means to secure the pedicle. It is placed upon the pedicle 
and screwed tightly, and the end of the pedicle is retained 
outside the abdomen by this means, placing the clamp trans- 
verse the incision. With the use of the clamp no ligation 
of the pedicle is required. Its advantage is that it is easy 
of application. Its disadvantages are, that in case the ped- 
icle is not very long it produces too much traction. It pre- 
vents the perfect closure of the incision, and the weight of 
the clamp resting upon the sensitive abdomen, is a source of 
irritation and sometimes causes much trouble. It requires 
much attention after the operation. It does not always pre- 
vent hemorrhage. J Strangulation of the intestines has oc- 
curred with its use. 

Objections to the Ligature. — Theoretically it is urged 
that the presence of the ligature and the sloughing of the 
stump of the pedicle produce peritonitis and septicaemia. 
This is not proven by experience (see Peaslee, page 445), 
but the contrary is abundantly demonstrated by Peaslee, 
Spiegelberg, Waldeyer, Veit, Simon, I. B. Brown, and others. 

* Transactions Anier. Inst., 1871. t Lancet, 1871, page 054. 

% Peaslee, page 453. 



330 EATON ON DISEASES OF WOMEN. 

Bringing the pedicle out through the incision, and trans- 
fixing it there by means of long needles, which fire arranged 
with points which may be removed, is another method. These 
needles are passed through the skin, cellular and muscular 
tissue, and peritonaeum, the same as we pass the needle to 
insert a suture, except that it is made to transfix the pedicle 
at about the point where the ligature is applied. While they 
are being inserted the assistants hold the abdominal walls in 
apposition, and steady the pedicle in the proper position. 
After about three needles are inserted, at intervals of about 
an inch, the ends of the ligature are twisted over the needles 
like the operation for hare-lip. The points of the needles 
are now removed, and the other sutures necessary to close 
the abdomen are inserted, and adhesive plaster is applied, as 
I have before mentioned. 

In 1846 Mr. Handyside* carried the ligature attached to 
the pedicle through the recto-vaginal cul-de-sac into the vag- 
ina (instead of cutting it short, as I recommend, and leaving 
it in the abdomen). Other surgeons have occasionally per- 
formed the operation in this manner. This establishes a com- 
munication frith the atmosphere and the peritonaeum, and is 
more objectionable than cutting the ligature short and leaving 
it in the abdomen, especially when the catgut ligature is 
used, as it produces very little or no irritation. 

Transfixing the pedicle is open to nearly the same objec- 
tions as the clamp. The pedicle must necessarily be very 
long, to allow of the adoption of this plan. 

Professor Peaslee uses a method of his own, but I do not 
know that others have adopted it. He gives cuts and full ex- 
planation in his work on " Ovarian Tumors," page 469. As 
the arrangement is quite complicated, I will not occupy the 
space to fully explain it, but simply say that the ligature is 
passed through a tube, which is left in the incision, supported 
by a cross-bar. 

-"Gross.," Vol. II, p. 871. 



OVARIOTOMY. 331 

It seems to me the plan is open to very serious objections 
on account of its allowing the admission of the atmosphere 
into the peritoneal cavity, and I can not see its advantages 
to be superior to other methods. 

Some authors have recommended leaving a tent in the 
most dependent portion of the incision. I can not approve 
this practice. 

After Treatment. 

Some patients require no after treatment, except rest, mild 
diet, and the removal of the sutures in about five days. These 
should be removed seriatim, being careful to straighten out 
the end of the wire we intend to draw out, so that it does 
not lacerate the tissues. As each suture is removed, adhe- 
sive plaster should be applied at once, and allowed to remain 
a week or more. 

In case of severe peritonitis supervening upon the operation 
of ovariotomy, we can hope for only moderate success from 
treatment. Why it is, I leave others to explain ; but such is 
the fact, which we may as well acknowledge. The symptoms 
as they arise in various cases are to be met by homoeopathic 
remedies applicable in other cases, only bearing in mind that 
Arnica internally is of the greatest value. Arnica, Aconite, 
Bell., Bry., China, Ars. alb., Nux, etc., will occasionally be 
indicated. Stimulants and opiates are to be avoided. 

I will again mention, as it has been so common to give 
opiates before and after this operation, I must be emphatic 
enough to be understood as objecting seriously to their use. 
Then, I say, unless the case is hopeless, and sure to die, 
give no opium in any form ; but, for the relief of pain which 
nothing else will relieve, in hopeless cases, give morphia for 
humanity's sake. 

HEMORRHAGE AFTER OVARIOTOMY. 

Hemorrhage may take place from the surfaces from which 
adhesions have been detached, or from the pedicle. It gen- 



332 EATON ON DISEASES OF WOMEN. 

erally takes place in from twelve to twenty-four hours after 
the operation, if at all, though in Koeberle's fourth case it 
occurred on the fourteenth day. In one of Dr. Clay's cases 
hemorrhage occurred on the second day. 

In case of hemorrhage, the physician in whose care the 
patient is left should have the assurance and nerve, as well 
as knowledge, to at once remove the sutures and other dress- 
ings, seize the pedicle, and ascertain if it bleeds, and, if so, 
place another ligature upon it at once ; and he should always 
have a suitable ligature at hand. If it is found that the ped- 
icle does not bleed, search must be made for the vessel which 
has been lacerated in the operation, which has broken loose, 
and when found it must be at once secured and ligated. The 
blood and clots should be removed as gently and expeditiously 
as possible, and the abdomen carefully sponged out. The in- 
cision should now be closed and dressed as before, and some 
egg-nog or wine whey may be given 

SEPTICEMIA OR PYAEMIA AFTER OVARIOTOMY. 
Symptoms. 

In septicaemia the symptoms are usually those character- 
izing the typhoid condition, and occurring after a serious 
operation as a result of the absorption of poisonous gases 
into the circulation; while pyaemia consists of the absorption 
of pus into the blood. 

The symptoms, as shown in general, are much alike, and 
as nothing but a microscopic examination of the blood would 
positively differentiate between these conditions, and as the 
treatment necessary is the same, w T e will not take time to 
discuss these conditions separately. We have the rapid, 
weak pulse; the dry, coated, red or brown tongue; dry, hot 
skin; and a haggard, exhausted countenance; and generally 
drowsiness. Sometimes rigors are present in alternation with 
flashes of heat, and are pathognomonic of the formation 



OVARIOTOMY. 



333 



of pus in a case which has shown evidence of inflammatory 
action for some time. 



Prognosis. 



Rather doubtful, although recoveries have taken place 
after severe attacks of septicaemia. (See Amer. Jour. Med. 
Sciences for January, 1856; also, ibid., April, 1863, and 
July, 1874.) 



Treatment, 



When symptoms of septicaemia arise an examination per 
vaginam should at once be made while the patient is semi- 
recumbent, in order to ascertain, if possible, the presence 
of a fluid in Douglas' cul-de-sac. If found, it should be 
tapped with a canula, through the posterior wall of the vag- 
ina, injected with Solution of Iodine, two or three grains to 
the ounce (with ten or fifteen grains of Potass, iodide added), 
and the drainage tube inserted and retained in the puncture. 
(See also Plate XIII.) The injections may be repeated 




G.TJEMANN &CQ. 
Fig. No. 28.— Drainage Tube. 

daily, and if pus is discharged we will find benefit in mak- 
ing the injection twice as strong. The remedies indicated 
are loci, Ars. iod., China, Rhus, Ferrum, etc.; sometimes 
Baptisia or Merc. In some instances the Liq. Sodce Chlo- 
rinatce, diluted with water, has been found useful as an 
injection into the pelvis, and given internally 3 s dilution, 
a teaspoonful every four hours. 

Temperature of Injection. — The temperature of the injec- 
tion should be about 98°. Care is necessary in this par- 
ticular. 

VOMITING. 

Vomiting may be caused by the anaesthetic used, or it 
may be a symptom of incipient peritonitis, too high temper- 



334 EATON ON DISEASES OF WOMEN. 

ature of the apartment, improper food, or other causes. It 
is a serious symptom after ovariotomy. It is liable to produce 
hemorrhage ; or it may produce serious traction upon the ped- 
icle, in case it has been secured by clamp or transfixed with 
needles. It may also detach a ligature which has been a little 
too loosely tied. 

Treatment, 

The surgeon who has not administered opium to his pa- 
tient will avoid many cases of vomiting following this opera- 
tion which he would otherwise have. So we may recollect a 
part of the treatment is preventive, in not giving opiates, as 
I have warned you before. In this, as other difficulties, it is 
best to try to remove the cause, if possible. See to it that 
the temperature of the room is not too high. If there is 
much tympanites of the stomach, give l x Trit. Potass, chlo. 
every half hour. If there are rigors, alternating with flashes 
of heat, give Ars. alb. For heat, accompanied with dizziness, 
rapid pulse, etc., with the vomiting, give Aconite. For passive 
vomiting, with no other special symptoms, I would depend 
upon Ipecac. Place a very large compress over the epigastric 
region, and bind it tightly with a band around the body. 

FAILURE OF THE ABDOMINAL PARIETES TO ADHERE. 

This occurred in Mr. Wale's fourth case and in Mr. Wells' 
twenty-second case. Of late years I find no account of such 
an occurrence. It results from either an improper adjustment 
of the tissues in applying the sutures, or as a result of too 
loose bandaging, so as to allow of too much movement, or not 
including the muscular and peritonseal structures in the 
sutures (simply stitching the skin together might readily 
result this way); or it may depend upon the bad condition 
of the patient, she having a low assimilative and recuperative 
power, causing a want of plasticity of the blood. 



OVARIOTOMY. 335 



Treatment. 

First give supporting diet; then the edges of the wound 
may be pared, the hemorrhage arrested, abdomen cleansed, 
and the sutures properly applied with the adhesive strips, as 
in first dressing; or the edges of the incision may be touched 
with strong nitric acid (using great care not to drop it into 
the cavity of the abdomen), and the parts placed in apposi- 
tion as after paring the sides of the incision. 

ABSCESS. 

Sometimes an abscess forms in the line of the incision 
(most likely to do so from the irritation of the clamp). 

Treatment. 

As soon as discovered it should be freely evacuated, and 
treated as if occurring in another locality. Vaseline is, per- 
haps, the best dressing for it. 

VAGINAL OVARIOTOMY. 

The removal of a small ovarian tumor through the vagina 
is possible, as has been demonstrated by Professor T. G. 
Thomas,* of New York. The operation is only possible in 
small tumors without adhesions, and it is a question, whether 
their removal should ever be attempted when small. Dr. T. 
reports his case as follows : 

"Drs. Peaslee, Noeggerath, and myself met in consulta- 
tion, and carefully investigated the case. „ . In discussing 
the subject of treatment, three plans were proposed : 1. That 
the cyst should be allowed to develop so that ovariotomy 
might be resorted to after some years of life had been passed 
in comparative comfort; 2. That the cyst should be tapped 
per vaginam ; and, 3. That the operation of ovariotomy should 
be performed through the fornix vaginae, in the same manner 

* Amer. Jour. Med. Sciences, April, 1870. 



336 EATON ON DISEASES OF WOMEN. 

that it is ordinarily accomplished through the abdominal 
walls. This last proposal was made by myself and urged 
upon these grounds : 

"1. I felt satisfied that the cyst being' movable (as 
proved by the fact that the knee-elbow position would at 
once cause it to roll out of the pelvis), sufficient space could 
be obtained through the fornix vaginae to withdraw the 
emptied sac. 

"2. I preferred this procedure to simple tapping, because 
drainage is very apt to follow paracentesis when practiced 
through the vagina, which might exhaust the patient and 
prevent a resort to vaginal ovariotomy at a later period. Fur- 
thermore, I did not regard the increase of danger attendant 
upon vaginal section as very great, even if removal of the 
cyst proved impossible ; for, in case of such an occurrence, 
I proposed simply to tap the exposed cyst, and close the 
vaginal opening by silver sutures. 

"3. I urged the adoption of the vaginal operation, rather 
than waiting for the full development of the cyst, because of 
the peculiarly anxious nature of the patient. After being 
informed of the nature of the disease she thought and spoke 
of almost nothing else; lost appetite, slept badly, and evidently 
depreciated in strength. From all that I could learn from her 
husband, who is a practitioner of medicine; from Dr. J. L. 
Brown, who had attended her, and from my own observation, 
I thought that she would prove a most unfavorable case for 
•ovariotomy, at the time of full development of the tumor; 
and, to repeat a consideration just given in connection with 
paracentesis, I regarded the tentative process as not attended 
by great risk, since it involved incision only into the depend- 
ent portion of the peritonaeum. 

"On February 6, 1870, at three P. M., I proceeded to 
operate, in the presence of Drs. Peaslee, Brown, Walker, 
Purdy, J. C. Smith, and Sproat. Dr. Purdy having anaes- 
thetized her with ether, she was placed in the knee-elbow 



OVARIOTOMY. 337 

position, and secured upon the apparatus of Dr. Bozeman. 
This apparatus not only completely secures the patient in 
this position by straps and braces, but makes the position 
perfectly comfortable for any length of time, and also favors 
the administration of an anaesthetic. To prevent all possi- 
bility of the rectum falling into the line of incision, a rectal 
bougie was inserted for about five inches. Sims' speculum 
being now introduced, and the perineum and posterior vaginal 
wall lifted, I caught the fornix vaginae midway between the 
cervix and rectum with a tenaculum, drew it well down, and 
with a pair of long-handled scissors, one limb of which was 
placed against the rectum and the other against the cervix, 
cut into the peritonaeum at one stroke. 

" The first step of the operation being now accomplished, 
I proceeded to the second. The patient's position was 
changed to the dorsal decubitus, and, passing my finger 
through the vaginal incision, I distinctly touched the tumor, 
which had now fallen again into the pelvis, and fastened a 
tenaculum in its wall. With a small trocar I then punc- 
tured, one after the other, three cysts, which gave vent to 
about six or eight ounces of fluid, which looked precisely 
like vomited bile. Drawing upon the cyst it now passed 
without difficulty into the vagina. 

"For the third step of the operation the position of the 
patient was again changed. She was now placed in Sims' 
position on the left side, and his speculum introduced. Pass- 
ing through the pedicle, at its point of exit from the vaginal 
roof, a needle armed with a strong, double-silk ligature, I 
tied each half of the penetrated tissue and cut off the cyst 
and ligature. The cul-de-sac of Douglas was then sponged, 
the pedicle returned to the abdominal cavity, the incision in 
the vagina closed by one silver suture, and the patient put to 
bed. The entire operation occupied thirty-five minutes, and 
presented no difficulties other than those slight ones inci- 
dental to ligature of a pedicle at some distance up the vagina. 



338 EATON ON DISEASES OF WOMEN. 

fi Subsequent to the operation the patient was kept quiet 
and free from pain by opium, sustained by fluid food, and 
strictly confined to the supine posture. Her only discomfort 
arose from sleeplessness and nausea which followed the use 
of the anaesthetic, and for ten days she progressed without 
any unfavorable symptom. At this time, being allowed to 
leave the bed and lie upon the lounge, she exerted herself 
unduly, and an attack of peri-uterine cellulitis invaded the 
right broad ligament. The pulse became rapid, the skin hot 
and dry, and a phlegmonous mass, as large as the fist, hard 
and painful to the touch, could be distinctly felt. This soon 
began to diminish, and now, at the end of the thirtieth day, 
has ceased to prove a source of any annoyance, while the 
general condition of the patient assures me that she is entirely 
out of danger." 

The case recovered. 

The operation is certainly more difficult than the operation 
by gastrotomy or abdominal section. It is more difficult to 
ligate the pedicle, and is not less dangerous than the ordinary 
operation. I have never thought this operation advisable. 

BED SWING. 

After ovariotomy and other serious operations, as well as 
in some painful diseases, it is convenient to have some means 
of moving the patient without causing her pain. The fol- 
lowing cut represents a very cheap and convenient arrange- 
ment, and I copy the description of it given by Dr. D. 
Milliken, in the Cincinnati Lancet and Clinic for September 
20,1879. He says: 

" Some months ago a puerperal patient of mine suffered 
from an exquisitely painful attack of pseudo-rheumatism in 
the hips and one shoulder during the course of a septic 
fever. For about thirty days it was necessary to catheterize 
her, and, as if to complete her WTetchedness, she lost con- 
trol of all the muscles of the rectum, expulsive and retain- 



OVARIOTOMY. 



339 



ing, so that she could neither expel her fseces completely 
nor retain them perfectly. Her vitality was as low as it 
could be, and I was in constant dread of bed sores. 

"When her case had assumed this aspect, it became 
perfectly evident that she would die merely from the pain 
inflicted by so much rolling and lifting as was necessary for 
cleanliness; and it was equally plain that she would die 
from sloughing if not kept scrupulously clean. 

"In this dilemma I took her husband to my office, and 
showed him pictures of the more approved fracture-beds 
and swings, and directed him to make some sort of apparatus 
to swing her from the bed. He had been trained in the best 
of all schools of invention — a farm — and was at the head of 
a manufacturing establishment, where his training was made 
more complete. I knew that his ingenuity, stimulated by 
the desperate necessities of the case, would devise some 
useful apparatus, but I was 
as much surprised as de- 
lighted to find, after a few 
hours, the admirable contri- 
vance which I have shown 
in the rude cut. 

" The inventor and builder 
had carried home some hick- 
ory stuff from a factory 
where buggy - felloes are 
steamed and bent. Of 
straight pieces he selected 
four, slightly knotty, and, 
therefore, unfit for bending. 
He took home, also, four 
felloes — two large ones and two small ones — which were un- 
salable on account of a slight tendency to splinter. The 
lumber, as specified, cost fifteen cents. He laid two of the 




Fig. No 29.— Bed Swing. 



340 EATON ON DISEASES OF WOMEN. 

i 

straight pieces, A, B, on the bed, near and parallel to its 
edges. At the head and foot of the bed he set up the larger 
felloes, A, C, A and B, D, B, and bolted them to the side- 
pieces at A, A, B, B, as shown. Then he laid two other 
straight pieces, E, F, on the bed parallel to the first pair, 
but closer to the patient's sides, and these he bolted to the 
ends of the two smaller felloes, E, G, E and F, H, F. On 
the highest point of the arch formed by each large felloe he 
bolted blocks, C and D, perforated for a long Avindlass, C, D, 
two inches in diameter. Hopes were attached to this wind- 
lass, and connected to the straight pieces lying close to the 
patient. The carpentry being thus finished, some strips of 
strong muslin were doubled and slipped under the patient — 
one under her head, one under her shoulders, another under 
her hips, and a wide one under her legs and thighs. When 
these strips had been stitched to the side-rails, the windlass 
was turned, and the patient was raised from the bed with- 
out pain. 

" She was not only lifted for all purposes of sponging, 
syringing, vaginal irrigation, and defecation, but she often 
asked to be raised merely for a change, and, as she said, ' to 
coot her back.' A number of little pads and cushions were 
provided, and, by rearranging these on the bed, points of 
pressure were shifted almost hourly, and all danger of bed 
sores was obviated. 

"You will observe that I am not reporting a case, but 
am praising one form of swing: 

"1. Because it is cheap. The lumber can not always be 
procured from a factory for fifteen cents, but can always 
be bought or borrowed at a carriage-shop for a trifling sum. 
The iron crank, the carriage-bolts, and the clothes-line cost 
very little. 

"% Because, resting on the bed, it takes up no space on 
the floor of the sick-room. 



OVARIOTOMY. - 341 

"3. Because it is staunch. The patient does not swing 
from tottering upright posts, but from the summits of arches 
based on the bed. 

"4. Because it can be built in an hour or two without 
noise. 

•• I have drawn the apparatus as it was built. Like 
every thing else, it is capable of . improvement. For a 
heavy patient another felloe, and .perhaps another rope, 
would be needed at the middle of the swing, where the 
weight of the hips tends to make it sag. The windlass and 
ropes ought to be so arranged that they could be quickly 
detached and laid away. We improved our apparatus by 
substituting a single piece of canvas for the four strips of 
muslin which originally supported the patient. This is a 
doubtful improvement."' 

I will suggest an improvement, however, which is to cut 
out from the canvas under the hips a piece, so that the evac- 
uation of the bowels may be accomplished without trouble, 
having this opening covered, when it is not needed, with a piece 
of canvas fastened to one side of the swing, and buckled to the 
other side, so that when the bowels were about to move we 
could unbuckle the one side, and slip the piece of canvas out, 
raise the bed, place the vessel under the opening to receive 
the feces, and afterwards remove it, let down the bed. and 
slip the piece of canvas under the patient, and fasten it with 
the buckles. 



342 EATON ON DISEASES OF WOMEN. 



CHAPTER XXVI. 

UTERINE FIBROMA— MYOMA— FIBROUS TUMORS OF THE UTERUS. 

Fibroid tumors of the uterus are much more common than 
is generally supposed by the profession, as in many cases 
they are of small size, and are not discovered till after death. 
Klob estimates that over forty per cent of women who die 
over the age of fifty years are affected with uterine fibroma, 
while Boyle declares that 20 per cent of those who die over 
thirty-five years of age are so affected. They have not been 
found before the age of puberty. They are more frequent 
relatively among negresses and mulatto women than among 
the whites. 

Etiology. 

Undoubtedly some local irritation at the point where the 
tumor originates causes its development. This irritation 
might arise from external violence, little noticed at the time, 
and soon forgotten ; or from the retention of a small bit of 
placenta ; or from the use of instruments to produce abortion. 
Some authors have claimed sterility as a cause ; but it is 
rather a result than a cause. About forty-five per cent of 
patients who have been discovered to be affected with uterine 
fibroma have been sterile. 

Pathological Anatomy. 

The fibroid tumor, when examined with the microscope, 
consists of unstriated muscular fiber and connective tissue. 
The connective tissue is firm, white, and almost cartilaginous. 
The arrangement of fibers is concentric. The tumor is scant- 
ily supplied with blood-vessels, and almost or quite destitute 
of nerves. The tumor may undergo changes, among which 



UTERINE FIBROMA. 



343 



are softening, fatty degeneration, oedema, induration, calca- 
reous degeneration, etc. 

Klob mentions one case of primary carcinomatous degen- 
eration, which is the only one on record. Extension of car- 
cinoma from neighboring parts is more common. Sarcomatous 
degeneration is still more frequent. 

Varieties of Fibroids. — We have the subserous, the sub- 
mucous, the infra-mural or interstitial varieties. The first two 
may be pedunculated; the submucous projecting into the 
uterine cavity, and, when attached to the uterine tissue by a 
pedicle, called a fibrous polypus (which, owing to its peculiar- 
ity, will be discussed separately) ; the subserous projecting 
into the abdominal cavity. It may either be pedunculated or 
non-pedunculated. The intra-muial variety develops in the 
muscular tissue, either of the body or cervix, its more com- 
mon seat being in the body. I will insert a few cuts to rep- 
resent the different varieties of uterine fibroma. 






Fig. No. 30.— Subserous Fi- 
broid op the Uterus. 



Fig. No. 31.— Submucous Fi- 
broid of the Uterus. 



Fig. No. 32. — Fibroma 

of the Nkck of 

the Uterus. 



Symptoms. 

Subserous fibroids, when small, produce little disturbance 
in the system, and give rise to few symptoms. They tend to 
produce displacements of the uterus, however, from their 
weight, as, when situated in the anterior portion of the body 
of the uterus, they tend to antivert or antiflex the organ, and 



344 EATON ON DISEASES OF WOMEN. 

when in Hie posterior part they produce retro-version or retro- 
flexion, or a, lateral flexion when entirely to one side. With 
these flexions there is some tendency to prolapse as well. In 
the large development of subserous-fibrous or fibro-cystic 
tumors of the uterus, we have similar symptoms to those we 
have in ovarian cystoma, (more especially the dermoid vari- 
ety), together with some enlargement of the uterus. If the 
tumor is pedunculated, there is less enlargement of the length 
of the cavity of the uterus than in the intra-mural form. 

In the submucous variety (where the tumor projects into 
the cavity of the uterus) we have also an enlargement of 
the size of the cavity of the uterus, but the space is occu- 
pied largely by the tumor, and the sound may pass six or 
eight inches up by the side of the tumor, and, if pedun- 
culated, may sweep nearly all around it; while, if non- 
pedunculated, we can only pass the sound up on one side. 

In the submucous form of uterine fibroids we have great 
disturbance of the general health early in the disease (while 
the tumor is small), accompanied by excessive floodings, in 
many cases, although I have seen exceptional instances 
where, owing to the tolerance of the uterus, little hemor- 
rhage or general disturbance was manifested, the tumor be- 
ing discovered by examination with the sound, while seek- 
ing to discover displacement, which we suspected from long 
continued pain in the knee, in one instance; in another, 
chronic pain in the back, with some gastric derangement. 
I have now a patient, who has flowed very little for over a 
year, who has a large intra-mural, submucous fibroid. She 

formerly flowed excessively, but was treated by Dr. , 

of this city, with daily injections into the tumor of Ergotine. 
causing great inflammation, which has caused adhesion of 
the tumor to the entire intra-uterine surface. The lady 
(widow of a deceased prominent allopathic physician of Cin- 
cinnati) is now in the enjoyment of quite good health, since 
I succeeded in subduing the inflammation, and the injections 



UTERINE FIBROMA. 345 

of Ergotine seem to have accomplished the arrest of the 
hemorrhage most efficiently, although the tumor remains as 
large as ever. 

Diagnosis of Uterine Kioroids from Pregnancy. 

In pregnancy we usually have a cessation of menstrua- 
tion, while in subserous uterine fibroma it is normal, or in 
excess, and in submucous uterine fibroids it is almost uni- 
formly "in excess. The fibrous tumor develops more slowly 
than pregnancy. The neck of the uterus is obliterated in 
case of submucous uterine tumors when the tumor has ad- 
vanced to the size of the uterus at about four or five months 
of gestation, whereas in pregnancy it is not obliterated till 
three or four months later. 

Diagnosis from Atresia of external Os witn Haematometra. 

In atresia of the external os with haematometra we also 
have obliteration of the cervix early in the disease, but 
there being no flow in atresia and a free flow in fibroid 
tumors of the uterus, we need not be misled in diagnosis. 
In making a digital examination of a suspected fibroid of 
the uterus it is well to select the menstrual period, as then 
the os is more open, and will, in case of tumors of the 
uterus, often admit the index finger, and we are able to feel 
the tumor, and more clearly make out its size, shape, and 
attachment. When we can not do this, insert sponge tents 
till we dilate the os sufficiently to make the examination 
thoroughly. 

Prognosis. 

The prognosis depends much upon the variety, size, and 
attachment of the tumor, as well as upon the treatment 
used. The polypoid variety of the submucous tumor usually 
requires an operation for its removal, and we may expect 
success if the patient is in a favorable condition. (I have lost 
but one case out of over one hundred operations of .this 



346 EATON ON DISEASES OF WOMEN. 

kind I have performed, and that was a lady from College 
Hill, Ohio — a patient of Dr. Vance — who died from cancer 
of the breast about a year after I removed the fibroid from 
the uterus, and I think life was prolonged in this case even, 
as it arrested the hemorrhage from the uterus — from which 
she had suffered for over two years — and for several months 
after I operated her health was improved). The small sub- 
serous fibroids give no trouble, unless they enlarge and take 
on, also, a cystic formation. Larcher* reports a case of 
rupture of the uterus from a uterine fibroid. 

Treatment. 

In large' fibro-cystic tumors of the uterus, which are, of 
course, of the subserous variety, and are pedunculated (which 
can not always be positively ascertained, however, till the ab- 
domen is opened and the pedicle is explored), the operation 
required is very similar to ovariotomy. 

The pedicle may be ligated singly if small, or it may, if 
large, be divided into two or three parts in the ligation by 
passing a needle armed with a double ligature (catgut is pref- 
erable). Tie the ligatures tightly with three knots each. Have 
the ligatures interlock in this manner (Fig. 
33), otherwise they might tear apart the dif- 
ferent portions of the pedicle separately lig- 
ated, causing hemorrhage. Cut them short, 
and leave them in the abdomen. The opera- 
tion will have to be abandoned in some cases, 
fig. no. 33. or e i se extirpate the uterus by ligating it 

above the vaginal juncture, and then removing the uterus 
with the tumor. (See Extirpation of the Uterus.) When 
it is found that the attachments are so very extensive as to 
be too large to ligate, unless extirpation of the entire uterus 
is performed, it may be attempted in desperate cases, as the 
result of recent operations seems to justify the operation, 

* Barnes's " Diseases of Women," p. 327. 




UTERINE FIBROMA. 



347 



which I will discuss under the head of "Extirpation of the 
Uterus." 

The removal of submucous tumors of the uterus which 
are pedunculated (termed polypi) I will speak of under the 
head of u Uterine Polypi." 

The non-penunculated, submucous, fibrous tumor of the 
uterus may be removed in the following manner by what is 
called enucleation: First of all, the os uteri must be as fully 
dilated as possible; or. it may be incised after the patient 
is placed under an anaesthetic, and we can then pass the hand, 
or at least two fingers, high up into the uterus, having its 
fundus pressed upon by assistants through the abdominal 
wall. We next pass up between the fingers we have intro- 
duced a long-handled bistoury, and make an incision into the 
tumor as long as convenient. We now withdraw the instru- 
ment, and peel back the coverings of the tumor as well as 
we can, and if we can entirely detach the tumor from its 
inclosed sheath in this way, aided by the use of Sims' 
enucleators, it is best; but if it can only be partially de- 



^ 




Fig. No. 34. — Sims' Enucleators. 



tached we should seize the detached portion with the vul- 
sellum forceps (see Plate X), or Nekton's forceps (see Plate 
XI), and as we make traction with them continue to attempt 
to make further separation with the fingers or enucleators. 
If the tumor can not be extracted entire, it may be torn 



348 EATON ON DISEASES OF WOMEN. 

off piecemeal, scraping the interior of the sac with the circu- 
lar sharp enucleators or curettes (using care not to injure the 
uterus), thus removing all of the tumor, as I did in a case 
of this kind in a lady from Kentucky last year (and made 
a success of the operation). The tumors vitality in this 
case seemed io have been lost by the use of sponge-tents, 
used in dilating the os. and it became quite soft, although 
on the first attempt at dilatation, six weeks before, the tumor 
was solid and firm. 

In case we can draw down the enucleated tumor to the 
mouth of the vagina, or into the vagina even, we may sever 
its connection with the ecraseur; simply incising the tumor 
and allowing the contractions of the uterus to enucleate it, 
sometimes succeeds. Again, inserting tents into the sub- 
stance of the tumor and inducing suppuration is recom- 
mended ; but is more hazardous than enucleation. Professor 
By ford reports two successful operations of this kind. 

Mr. I. B. Brown reports sixteen cases treated by incis- 
ing the os uteri freely, causing an entire arrest of hemor- 
rhage in ten cases; in six of these cases the tumor materially 
diminished in size or entirely disappeared. When this pro- 
cedure is insufficient, Mr. Brown cuts into the tumor, and by 
twisting the knife around similar to coring an apple, removes a 
part of its central portion, then plugs the vagina to arrest 
hemorrhage. 

In performing either of these operations the patient 
should lie upon the side with the thighs flexed upon the 
abdomen, and the vagina should be dilated with Sims' im- 
proved slit speculum held by an assistant. (See Plate No. III.) 
Professor Dan forth, of Milwaukee, has preserved a submucous 
fibroid of the uterus which he removed several years since 
by enucleation. The tumor weighed, when removed, eight 
pounds, and the patient recovered. 

Injecting the Tumor with Ergotine. — For some years 
the profession was elated over the expected successful treat- 



UTERINE EIBROMA. 349 

ment of fibrous tumors of the uterus with injections of 
Ergotine; but experience has not confirmed the good effect 
of this treatment to a sufficient extent to make it worthy of 
much confidence. The operation produces great pain, usually 
for several hours, and severe inflammation sometimes results. 

Electricity has been used to produce absorption of these 
tumors, with but very little success. 

Treatment by Sponge Tents. — My attention was directed 
some years since to a case related by Dr. Sims,* of New 
York, who accidentally left a sponge tent in the uterus for 
seven days which he had inserted to examine a fibrous polypus, 
and upon its removal found the polypus quite destroyed ; and 
I have taken the idea that pressure is good treatment in uter- 
ine polypi, and I believe it to be very serviceable in submu- 
cous fibroids. I have attempted this plan with twelve cases 
of polypi successfully, but in only one case of submucous 
intra-mural fibroid. In this case the effect was all that could 
be expected. The hemorrhage, which had been almost fatal 
for over fixe years, was cured, and I removed the tumor 
piecemeal with the vulsellum forceps by enucleation, finding 
it easily torn to pieces, and I was troubled with little hemor- 
rhage. In these case I would provide myself with about four 
sizes of sponge tents, the largest at least an inch in diameter 
when compressed, in length about four inches. The smallest 
size I introduce and allow to remain about eighteen hours, 
then another and another, and allow to remain about the 
same length of time. In this way we keep up constant press- 
ure, and they do not become very offensive in eighteen hours. 

Palliative Treatment in Cases which, for some Reason, it 
is not Desirable to adopt Operative Measures. — In displace- 
ments caused by the weight of small intra-mural fibroids, we 
should rectify the displacement, and retain the uterus in situ, 
even if we have to use the vaginal pessary in some form ; it 
being better to do this than to allow the patient to suffer from 

* Sims' Uterine Surgery, page 64. 



350 EATON ON DISEASES OF WOMEN. 

the sympathetic pains and derangement of general health con- 
sequent upon displacement of the uterus. 

Hemorrhage, which is so excessive in some instances, may 
be arrested with the tampon in the vagina, or the sponge tent 
and tampon combined. Ferruginous and astringent remedies 
used by the old-school have little effect, and I can say but 
little more in favor of Ipecac, Aconite, or other remedies used 
by homoeopaths (in this class of cases, though efficient in 
many other forms of hemorrhage). 

Tamponing the vagina or uterus is a necessity in many 
cases; and the most convenient and efficient vaginal tampon 
known is the French elastic rubber bag, with a tube and stop- 
cock. This a patient can introduce, and the nurse can inflate. 

The sponge tent arrests the hemorrhage, and prepares the 
womb for examination or operation, and if continued, and 
properly watched, will, I fully believe, in many cases, cause a 
destruction of the vitality of the tumor, arrest of its devel- 
opment, and, in some instances, its absorption and disappear- 
ance. We know it will do so in pedunculated fibroids, and 
I believe that it will exert a salutary effect upon submucous 
fibroids as well. I do not claim that one case demonstrates a 
principle ; but it is better than no trial. 

Of course the anaemia and general weakness caused by 
great loss of blood are to be remedied all we possibly can by 
nutritious diet and such remedies as China, Ars., Chi. ars., 
Merc, Nux, Rhus tox., etc., as homoeopathically indicated ; 
but it is best, in these cases of excessive hemorrhage, depres- 
sion, and exhaustion, to operate for the removal of the tumor, 
or at least try to arrest its growth and destroy its vitality, if 
possible ; but it may be first necessary to place the patient 
in a condition to bear operative measures. 

Liquid Persulphate of iron, as an intra-uterine injection in 
these cases, I most heartily condemn, as calculated to produce 
great irritation, with nothing more than temporary relief. 

Position may afford Relief. — In some cases the tumor 



UTERINE FIBROMA. 351 

just fills the pelvis, and produces strangury by pressing upon 
the urethra. In such a case lifting the tumor above the brim 
of the pelvis may afford very great relief, the distressing 
symptoms entirely disappearing; and the patient goes on for 
years without trouble, if the tumor be subserous or intra- 
mural. In case it is submucous, of course, the demand for 
operative procedure would still remain, as the hemorrhage 
would continue, although the other symptoms might be 
relieved. 

Where hemorrhage is active from a submucous, intra-mural 
fibroma of the uterus, and circumstances or the condition of 
the patient forbid its attempted removal, the ovaries may be 
removed, to stop the hemorrhage. Both ovaries may be re- 
moved through one opening in the abdominal cavity, as would 
be made for the removal of a small ovarian tumor; the open- 
ing may be made to either side of, or directly in, the median 
line. If the incision is made to one side of the median line, 
it should be made about four inches in length obliquely in a 
line from the anterior superior spinous process of the ilium to 
the symphysis pubis. The base, or pedicle, of the ovary 
should be ligated with catgut ligature, and replaced in the 
abdomen, closing the incision tightly with silver sutures and 
adhesive plaster. 

This operation has so far proven successful in every case. 
The first one to perform this operation for this purpose was 
Dr. Trenholme, of Canada, who operated in 1876, since 
which time Prof. Hegar, of Freiburg, Prof. Nusbaum, of 
Muncie, and Dr. Wm. Goodell, of Philadelphia, have per- 
formed the operation successfully, as regards the recovery, 
and also in arresting the hemorrhage from the tumors, and 
the tumors have diminished in size as well. 



352 



EATON ON DISEASES OF WOMEN. 



CHAPTER XXVII. 

UTERINE POLYPI. 




VEGETATIONS OF THE ENDOMETRIUM — UTERINE HYDATIDS — VASCULAR 
POLYPI — PLACENTAL AND GRANULAR POLYPI, ETC. 

The uterine polypus usually consists of a fibrous, pear- 
shaped tumor, attached to some portion of the internal sur- 
face of the uterus, by a pedicle or stem. The size of the 
pedicle varies somewhat with the size of 
the polypus ; although occasionally quite 
large polypi are attached by small pedicles, 
and, in other occasional instances, the small 
polypus has a pedicle about as thick as its 
own diameter. The fibrous uterine 'polypus 
usually exists singly, al- 
though I have known one 
instance where there was 
one quite large fibrous pol- 
ypus in connection with 
several small fibrous growths at the same 
time in the same uterus. The small mul- 
tiple fibrous growths of the body and cer- 
vix are termed vegetations of the endome- 
trium. The small and semi - organized 
growths are termed mucous polypi. 

Hydatids of the uterus consist of numer- 
ous small cystic tumors generally attached 
to each other like a bunch of grapes. The 
enlarged mucous polypi are shown in the 
annexed cut, representing the growths as they existed in a 
patient whom I treated about two years since. These 



Fig. No. 35. — Fibrous 

Polypus, with short 

Pedicle. 




Fig. No 



Mucous Pol- 
ypi and Constricted 
Vagina. 



UTERINE POLYPI. 353 

growths, about two inches in length, looked much like a 
leech as used by our old-school brethren, and consisted of 
semi-organized fibrous tissue covered with mucous membrane. 
These growths came away by the contractions of the uterus 
seeming to break them loose. They caused excessive hem- 
orrhage, and much pain was experienced previous to their 
discharge, which usually occurred every few weeks, with no 
regularity, from two to twelve being discharged at a time. 
The patient was about thirty-five years of age, married ten 
years, barren and exceedingly reduced in strength from loss 
of blood, pain, and sympathetic gastric derangement. Her 
trouble had existed some seven }^ears. 

The vegetations of the endometrium or enlargement of the 
follicles of the cervix sometimes exist in great numbers. 
They are sometimes termed granulations of the cervical 
canal or granular tumors of the womb. Large mucous 
polypi, with large supply of blood vessels, are termed vas- 
cular polypi. 

The fibrous uterine polypus seldom reaches a greater size 
than that of a child's head, and they more frequently are 
expelled naturally or extracted artificially when of much 
smaller size. 

The single cystic growth of the cavity of the uterus sel- 
dom attains a large size, usually not as large as a child's head. 

Hydatids of the uterus sometimes attain to very great 
dimensions in their totality, though singly they are small. 
Their size often distends the uterus about the same as gesta- 
tion at term, and their presence has been mistaken for preg- 
nancy. They frequently occur in connection with pregnancy, 
and from their presence interrupt the regular course of ges- 
tation, and cause either a miscarriage or a premature delivery. 

Granulations of the cervix or vegetations of the endometrium 
do not cause any considerable enlargement of the uterus. 
Neither do mucous polypi of the uterus produce any great 
enlargement of the organ. 

23 



354 



EATON ON DISEASES OF WOMEN. 



Hydatid developments are not confined to the uterus, but 
have been found in the liver, lungs, testicles, mammce, and even 
in bone. 

The granular potypi are quite uncommon in the uterus; bu: 
the vascular polypi are occasionally met with in this organ. 
Polypi of the uterus are most common in the middle-aged 
and older women. They sometimes are developed in young 
women even in the virgin state. 

Polypi of the uterus may be attached to the interior of 
the body or cervix, and sometimes just at 
the margin of the os, and hang suspended 
in the vagina. When attached at the mar- 
gin of the os they produce no hemorrhage 
or other disturbance, as a rule, and are dis- 
covered in this situation accidentally, the 
patient not having thought of the existence 
of any thing of the kind. Polypi attached 
in this locality are usually not larger than a, 
fig. no. 37. hickory-nut. 

FlBR LoNG P rE™ E WITH Placental polypus may develop from a, 
partially retained placenta, or rather from the retention of a 
part of the placenta, on account of inflammatory action hav- 
ing caused abnormal adhesions between the placenta and 
uterus. They are a source of active hemorrhage. C. Braun 
(Dublin "Med. Jour.," 1851) describes this variety of 
polypus of the uterus. Braun relates five cases ; but, from 
the description, I think it would be as well to designate 
these cases as partially retained placenta, and not classify 
them under the head of polypi at all. When removed they 
certainly have no disposition to return. 

Etiology and Morbid Anatomy. 

Doubtless, the origin of the fibrous polypi vegetations of 
the endometrium and mucous polypi may be found in an 
inflammatory, condition. The reason why some cases of in- 




UTERINE POLYPI. 355 

flammation, and injury causing inflammation, develop tumors 
in the uterus of various forms and qualities in some instances 
and not in others, is hard to explain ; in fact, I may say, 
explanation is impossible in the present state of our knowl- 
edge. From all that I can learn I believe that the fibrous 
polvpus originates in the fibrous tissue of the uterus, like an 
intra-mural, submucous, or subserous fibroma of the uterus, 
from inflammation at this particular point in the organ. 
Around this point of inflammatory action (which may have 
been caused by a bruise accidentally received during gestation, 
in labor, or otherwise), there is exuded a plastic material, 
which organizes into a hard mass, usually largely consisting 
of white fibrous tissue, especially if the injury is upon the 
internal surface of the uterine muscular tissue beneath the 
mucous surface. The muscular contractions of the uterus 
press this hard mass into its cavity, and it gradually becomes 
pedunculated through these contractions of the uterine mus- 
cular tissue. The polypi of the uterus seldom contain any 
muscular tissue or nerves of any size. Why this is so, and 
why they consist of white fibrous, and some yellow elastic 
tissue, I can not explain. They sometimes contain sinuses 
filled with serous liquid. Generally a single blood vessel is 
all the means they have of nourishment. Their growth is 
consequently slow. Arising beneath the mucous membrane 
they push it before them, and it is this which constitutes 
their covering as they develop. It is not unlikely that the 
use of instruments to produce abortion, or rude efforts in 
performing versions, in labor, or the imperfect detachment of 
the placenta may be a cause of the development of the irri- 
tation which tends to the development of these tumors. 

Vegetations of the endometrium are enlarged granulations 
which have been thrown out to repair injuries received by 
.the interior of the cervix. They are not ordinarily covered 
with mucous membrane, and bleed on the slightest touch. 
They may resemble enlarged mucous follicles ; but the mucous 



356 EATON ON DISEASES OE WOMEN. 

follicle is covered with mucous membrane. The enlarged 
mucous follicle in time becomes the mucous polypus. This en- 
largement is probably due to closure of the ducts of the folli- 
cles in some instances ; in others, due to inflammation in 
these follicles or glands, and consequent effusion of blood 
and serum, which partially organizes. These polypi have a 
resemblance to muscular tissue, though not firm and well 
organized. 

The single cyst is probably an immensely enlarged mucous 
follicle or an effusion of serous fluid under the endometrium, 
which is forced into the uterine cavity by the uterine mus- 
cular contractions, in the same manner that the fibrous poly- 
pus is formed, and becomes pedunculated by these contrac- 
tions, and enlarges b}' means of continuous effusions. The 
covering of these uterine cysts consists of mucous membrane 
only. They resemble moles, which I will speak of separ- 
ately, as they differ in some important respects. 

Hydatids are transparent cysts or vesicles. Their con- 
tents resembling pure water, they have been supposed to be 
independent animals, and were called by Laennec " cysti- 
cercusr Mr. M. Edwards, in his "Elemens de Zoologie-Animaux 
sans Vertebres" says : " The hydatids are generally consid- 
ered as the last link in the series of intestinal worms ; but 
the bodies described under this title are perhaps not real 
animals, and seem rather to be mere pathological products." 
They seem to be caused in the uterus by a sort of dropsy 
of the chorion, which acts to destroy the life of the ovum. 
Sometimes, 'tis true, the chorion is only slightly affected 
with this cystic degeneration in these cases, and consequently 
the embryo is not disturbed in its growth and perfect 
development. 

It is a question whether hydatids in the uterus are not 
always the result of unhealthy or imperfect impregnation. 
We know they are situated in the placenta in many instances, 
and as they destroy the healthy circulation, or are the result 



UTERINE POL YPL 357 

of abnormal development of the vessels of the placenta, 
they interfere directly with the nutrition of the impregnated 
ovum. I would not, however, dare to say that the existence 
of hydatids was positive proof of copulation having taken 
place, as I have seen them discharged from a woman where 
I had every reason to believe there had never been copula- 
tion; and in another where copulation had been unknown 
for upwards of two years. (The single cysts of the uterus 
are not an indication of imperfect impregnation, as I have 
seen them also in the class of cases just mentioned.) The 
occurrence of hydatids in other organs and tissues is also evi- 
dence that they are not caused from imperfect impregnation. 

Diagnosis. 

Symptoms of inflammation may or may not exist in 
cases of uterine polypi. More frequently we have present 
an alarming hemorrhage from the uterus at times, and the 
dribbling of blood quite constantly, although during the 
early development of the fibrous or cystic growths we may 
have only an increase in quantity or duration of the ordi- 
nary catamenia. These floodings are usually accompanied 
with some pain in the uterus of a bearing down or expulsive 
character. These symptoms go on increasing in severity till 
the patient becomes alarmed, and the physician is consulted. 
In some instances in the development of hydatids the men- 
strual flow ceases, which induces a suspicion of impregnation 
being the cause of the cessation of menstruation. The block- 
ing of the internal part of the cervix by inflammatory action 
or the development of abnormal growths may for a time 
arrest the regular flow, and it may then come on with great 
violence when no tumor is there. When tumors are present 
in the uterus after the effort of nature to expel them from the 
uterine cavity is established, and the contractions of the mus- 
cular fibers in the body of the uterus are supplemented by a 
relaxed condition of the cervix, there is an excessive flow. 



358 EATON ON DISEASES OF WOMEN. 

Sterility is, of course, the rule in all cases of uterine 
polypi when developed to any considerable extent, and is to 
be considered in the diagnosis of the case. The history 
of the case aids us in the diagnosis in some measure. The 
absence of the catamenia for several months, followed by a 
flow free and almost continuous for a period of weeks, would 
indicate a threatened abortion in the young married woman, 
while in women aged from forty to forty-five years it might 
be indicative of the climacteric period. There are, however, 
exceptions in these cases where these symptoms are indica- 
tive of miscarriage, even in women over fifty years of age. 
And in the case of the unmarried we must bear in mind that 
the condition of pregnancy is not an impossibility; and we 
should also recollect that, in the case of the young married 
woman, a tumor in the uterus is not impossible. 

Debility, ancemia, gastric disturbances, headache, backache, 
uterine pains, etc., as well as the uterine hemorrhage, may be 
due to either uterine polypi, intra-mural fibrous tumors of the 
uterus, threatened abortion, retention of the placenta after 
miscarriage, inflammation, or ulcerations of the uterus ; hence 
we have no means of making a positive diagnosis except by 
physical examination. I may except some cases of mucous 
polypi which are detached, and are discharged by the 
contractions of the uterus, when we have evidence of the 
nature of the difficulty without physical examination. In 
attempting a physical examination we may find that touch- 
ing the os uteri gives rise to considerable hemorrhage. This 
fact is indicative of the granulation of the cervical canal, 
vegetations of the endometrium, cauliflower excrescence or 
cancerous ulceration, or mucous polypi, and must be differ- 
entiated from the ulcerated condition of the cervix by spec- 
ular examination. 

The exact nature of the polypoid growth can only be 
discovered in some cases by dilating the os and cervix with 
sponge tents; sometimes, however, a mucous polypus, or sev- 



UTERINE POL YPL 359 

eral polypi of this variety, are felt protruding from the os. 
In these varieties of polypi the uterus is felt not greatly 
enlarged. If we make use of the speculum we may attempt 
to pass the uterine sound, in case digital examination has 
caused no flow, and we desire to diagnose the case more 
clearly. If the history of the case shows several months 
of hemorrhage, easily induced, even from copulation, we had 
better, before introducing the sound, provide ourselves with 
the Persulphate of Iron and a probe wrapped with cotton, 
that we may be ready to arrest any excessive flow which 
may be induced by the examination. In case of mucous 
polypi, granulations of the cervix, and vegetations of the 
endometrium, some hemorrhage is likely to be induced by 
the introduction of the sound a half-inch inside the os uteri, 
and I consider this evidence sufficient to make the diagnosis, 
taken in connection with the history of the case, and the 
slightly open condition of the os, and the slight enlargement 
of the uterus. 

When we find that the uterus is much enlarged, and 
the history of the case shows that hemorrhage has existed for 
many months, and there has not been any discharge of mu- 
cous tumors or hydatids, we may be quite sure we have to 
deal with a fibrous polypus. Upon inserting the sound in 
this case no hemorrhage is induced while the sound is in 
the cervix, and with care we may pass the sound up between 
the tumor and the interior of the uterus. This will give 
some information of the size of the tumor, when conjoined 
with external manipulation, with one hand upon the hypogas- 
trium. We may now gently sweep the sound around the in- 
terior of the uterus and around the tumor, and by this means 
ascertain the location of its attachment and the size of its 
pedicle. In case the tumor consists of a single cyst, or a 
mass of hydatids, we will probably rupture the cyst or cysts 
by the examination; and, perhaps, at first imagine we have 
accidentally ruptured the waters of an impregnated ovum. 



360 EATON ON DISEASES OF WOMEN. 

We should not .attempt the examination with the sound 
till we are satisfied that there is no pregnancy in the case, 
unless it be that a foetus has been expelled, and we desire to 
learn what keeps up the flow. This flow might be caused from 
a retained and partially attached placenta, as well as a fibrous 
polypus, or a mass of hydatids. To make the diagnosis sure, 
and at the same time make a point in treatment, we may di- 
late the cervix with sponge tents, and then introduce one or 
two fingers, and more clearly make out the nature of the dif- 
ficulty. By doing this we lose nothing in any event, as the 
case demands local treatment whatever cause may be operat- 
ing to produce the symptoms; especially is this true if renie-' 
dies have been tried in vain before the examination is 
attempted. 

The dilatation of the cervix sufficiently to allow of the 
introduction of one finger into its canal will enable us to 
feel the round, smooth surface of the potypus, if it be of a 
fibroid character. If the mass be hydatid, we feel it soft and 
compressible to some extent, and probably the pressure of 
the finger to determine its nature will break loose some of 
the cysts, or lacerate them so as to allow of the escape of 
their contents. 

Some cases of uterine polypi may tend to*cause ante- or 
retro-version, ante- or retro-flexion; and in cases where these 
displacements exist, we may have the train of symptoms pre- 
sent in instances of these misplacements from other causes. 
Inflammation of the uterus may be caused by the irritation 
of the uterine polypus, and this inflammation may extend to 
the cellular tissue, or to the peritonaeum. 

Differential Diagnosis. 

The condition most likely to be mistaken for a fibrous poly- 
pus is chronic partial inversion of the uterus. First, if we 
feel the uterus round and smooth through the abdominal 
walls, by placing one hand over the abdomen, and the other 



UTERINE POLYPI. 361 

pressing the organ up, with two fingers in the vagina, there 
is no inversion. In inversion of the uterus the history of the 
case must show a previous labor, followed soon by similar 
symptoms to those now present, or the discharge (naturally or 
artificially) of a fibrous uterine polypus, which might have in- 
verted the fundus. One fibrous polypus having been thrown 
off, or removed by art, we may know that if the time is not 
long since past we have not a case of fibroid, but most likely 
an inversion of the fundus of the uterus, simulating, by the 
feel, the fibrous polypus. 

The single cyst, or the hydatid mass, may be simulated 
by a product of conception in the shape of a mole or a dead 
foetus with the membranes intact. Whichever condition is 
present is immaterial, as the indication in either case is to 
remove the mass; hence time need not be spent to differen- 
tiate at this stage of the case. 

In cases Avhere the fibrous uterine polypus of large size 
is expelled into the vagina the condition simulates complete 
inversion of the uterus, and this displacement should be well 
understood in order to differentiate between these two con- 
ditions. If the extruded polypus is of small size there is 
little or no danger of making a wrong diagnosis, as it may 
be felt so easily that error is not likely to occur. The head 
of a small foetus, having passed the os, might somewhat 
resemble the small-sized polypus when expelled from the 
cervix. But the feel of the head of the foetus is harder in 
some spots than in others, while the polypus is of uniform 
density. The history of the case aids the diagnosis. Trac- 
tion upon the head of the foetus will soon deliver it, and 
settle any doubt we may have had in regard to its nature. 
We may also bear in mind that the fibrous polypus is insens- 
ible, and does not bleed from its own surface; while the 
inverted uterus is sensitive, and bleeds from its surface. 



362 EATON ON DISEASES OF WOMEN. 

Prognosis. 

The prognosis of uterine polypi is favorable, the efforts 
of nature being sometimes sufficient to effect a cure, but in 
other instances the resources of art are required to remove 
the difficulty. In the fibrous variety of polypi their removal 
is usually the end of the trouble. In the mucous variety, 
as well as the granular, there is a disposition to return after 
removal, and great thoroughness of treatment is necessary 
to prevent their continuous formation. The single cyst is 
seldom or never reproduced. The hydatid growth may be 
again developed after removal. If left to themselves all 
varieties of uterine polypi (except the fibrous with a pedicle 
attached at or near the os, which hangs loose in the vagina) 
are likely to exhaust the patient from loss of blood and 
weakness induced by the anaemia consequent upon this 
drain upon the vital fluid ; hence the outlook is not encour- 
aging for happiness and strength when the tumors are left 
to themselves, although life may be prolonged for a long 
time. Occasionally life may be lost, mainly on account of 
the excessive flow caused by the presence in the uterus 
of polypoid growths. Other diseases develop more readily 
on account of the exhaustion produced by the excessive 
hemorrhages induced by these growths. 

Larcher* describes a case of spontaneous rupture of the 
uterus from intra-uterine polypus. The patient died, after 
having suffered from hemorrhage and from symptoms of 
peritonitis. The autopsy revealed a polypus in the uterine 
cavity, attached to the anterior wall; and the opposite side 
was found ulcerated and torn through, and communicating 
with the cavity of the abdomen. 

Dr. Cockle f reports a case of death resulting from a 
fibrous uterine polypus which had partially decayed, and 
some of the decayed matter had found its way through the 

*Arch. Gen. de Med., Nov., 18G7. \ Med. Times and Gazette, 1863. 



UTERINE POLYPI. 363 

Fallopian tube into the abdominal cavity, causing fatal peri- 
tonitis. 

These cases of a fatal termination in this manner are ex- 
ceedingly rare, however, and the rule is, that they do not ter- 
minate fatally, except, as I have before mentioned, through 
exhaustion, and the supervention of other diseases. In some 
instances where the pedicle of the polypus is long, and it is 
expelled into the vagina, the contractions of the cervix 
strangulate the neck of the polypus, and it loses its vital- 
ity, the pedicle sloughs and the tumor spontaneously drops 
off. The pressure of a developing foetus may sometimes 
destroy the polypus, and cause it to become detached from 
the uterus, or soften and slough away. It is usual, how- 
ever, that pregnancy does not occur iu a case of uterine poly- 
pus, and if it does, it is more common that the foetus is de- 
stroyed, and a miscarriage is induced by the presence of 
the polypus, instead of the polypus being destroyed by the 
product of conception. 

Treatment. 

Usually the first indication is to arrest the hemorrhage. 
For this purpose Aconite is the indicated remedy, if there is 
fever, or rapid pulse; Nux, or Secede, if there is a slow pulse 
with weakness and spasmodic contractions of the uterus ; Ipecac ', 
if nausea or vomiting complicate the case; China, if there has 
been great loss of blood, and great exhaustion is present; Ars. 
alb., for chilliness, alternated with heat and hot flashes. Cloths 
wrung out of cold water applied to the epigastrium are of 
service. Lemonade may be drank. 

These means failing, the tampon should be used in the 
vagina if the flow continues excessive. Formerly the tampon 
was composed of a silk handkerchief, formed by pressing its 
central portion up to the os, and distending it with bits of 
cotton, or pieces of cloth, and this form of tampon may still 
be used if we can not obtain anything better at the time. 



364 EATON ON DISEASES OE WOMEN. 

A more convenient method of tamponing the vagina is by 
means of the gum elastic bag, or colpeurgnter, having an elas- 
tic tube attached, through which we may introduce the air, 
and distend the bag to the full capacity of the vagina, then 
tie the tube, or prevent the escape of the air, by means of a 
stop-cock. This procedure enables us to take time to con- 
sider, and also gives the patient an opportunity to regain 
strength. 

The tampon should be removed in twenty-four hours, for if 
it was left much longer, the decomposition of the retained blood 
might become very offensive, and even dangerous, from absorp- 
tion. After removal of the tampon, if the patient is weak 
and exhausted, we may reapply it, daily, for a week or so, 
till the patient is in better condition. 

Ferrum, China, Nux, Phos., or Secale, are often indicated 
in this class of patients ; under these circumstances beef tea, 
soup, raiv eggs, or milk, should be allowed. Let the patient 
drink freely of cold water. 

The next step in the treatment is to dilate the cervix 
uteri, in either form of polypi, which are contained within the 
uterine cavity. When they are found hanging in the vagina 
attached to the margin of the os, or by means of a pedicle 
attached within the uterine cavity, no dilatation of the cervi- 
cal canal is necessary; but we may at once proceed to re- 
move them by torsion, the ligature, with scissors, or the chain, 
or wire ecraseur. 

Operation. — Before deciding what means to use in the 
removal of a polypus hanging in the vagina we should ascer- 
tain the size of its pedicle. If the pedicle is as large as the 
finger, or larger, there is no doubt but that the ligature or 
the ecraseur is demanded. Even in case the pedicle is 
as small as an ordinary lead pencil the ligature or ecraseur 
is the safer plan, if the pedicle is firm, round, and rigid. In 
case the pedicle is very thin, but as broad as the finger, the 
ligature or ecraseur is demanded. If the pedicle is thin, 



UTERINE POL YPI. 365 

loose, and not more than a fourth of an inch in width, tor- 
sion may be attempted. In removing a polypus by torsion 
the tumor is seized with the long-handled uterine dressing- 
forceps, if it is of very small size (and if of the size of a 
hickory-nut, or larger, with the vulsellum forceps, or the tumor 
forceps), and the tumor is then twisted around and around 
upon itself a half-dozen times; at the same time we make 
slight traction. If the pedicle is not twisted off by this 




Fig. No. 38.— -Nelatox's Tumor Forceps. 



much effort we should desist in our efforts to remove it in 
this manner, for serious cellulitis, metritis, or endo-metritis 
might result from great violence in efforts to remove by 
torsion. Torsion failing, we should remove with the ecraseur, 
or the ligature, and scissors, as in cases of polypi with thick 
pedicles. 

Sponge Tents. — In case we feel quite sure in our diagnosis 
of a fibrous polypus of large size, we should provide our- 
selves with sponge tents of much larger size than are usually 
kept for sale. We should have at hand some as large as 
the finger, and others much larger, so that we may obtain 
a dilatation which will enable us to get at the polypus. The 
largest sponge tents kept on sale do not dilate the cervical 
canal more than to about the size of the finger, and this is 
not large enough to enable us to do more than to make 
a positive diagnosis. We had better also be prepared to 
proceed with the removal of the tumor as soon as the cervix 
is dilated, in case the patient's strength is sufficient to jus- 
tify the attempt. 

The tent should be dipped into carbolized olive oil before 



366 EA TON ON DISEASES OF WOMEN. 

it is inserted; and the tent should be inserted with the 
sponge tent applicator. (See cut.) A size of tent should 
be selected which can 
be readily introduced. 
This first tent may re- FlG - No - 39 - Emmet ' s applicator. 

main from twelve to eighteen hours, when it should be re- 
moved, and another inserted as large as can be introduced. 
This may remain till fully expanded, then removed, and 
have another still larger inserted, till we can seize the poly- 
pus with the vulsellum forceps, and draw it down, or pass the 
loop of an ecraseur chain over it, and by tightening it sever 
the pedicle (the tent effectually controls the hemorrhage). 

Sometimes voluntary uterine contractions come on, and 
sometimes we may induce them by giving Secede cor., in doses 
of twenty drops of the Flu. ext., or 3 doses of the Tr. in 
warm water every half hour till three doses are used. In 
this way the polypus sometimes is expelled into the vagina 
like the head of a child in regular labor. I have seen them 
delivered into the vagina of so large a size that they com- 
pletely filled the pelvis, being as compact as the head of a 
large child at full term. In this case the operation for 
removal is very difficult, but it can be accomplished with the 
use of some ingenuity. 

In these cases the chain of the ecraseur is not long 
enough to allow of making a loop large enough to pass over 
the tumor, and we must lengthen it with a wire. We fasten 
the extremity of the loop to a silver male catheter with 
a thread, and carry it up by this means, having the ecraseur 
held by an assistant, while we direct the catheter with the 
right hand, and expand the loop of the chain with the fingers 
of the left, and after getting the extremity of the loop up 
over the tumor press the handle of the ecraseur up on the 
opposite side of the polypus, and tighten the loop at the 
same time by making traction on the chain till we have it 
firmly adjusted about the pedicle, when we slip the chain 



UTERINE POL YPI. 367 

into its fastening, and proceed to turn the screw, and sever 
the pedicle. 

When the polypi are not larger than the fist they may 
be seized by the vidseUum forceps, and drawn down even ex- 
terior to the body in some cases, bringing the pedicle into 
view between the labia, when the ecraseur may be easily 
applied, and the connection severed. We should then at 
once examine thoroughly to see whether or not we have 
inverted the uterus, and if so at once replace it. This will 
not occur unless the attachment is near the fundus. 

If the attachment of the pedicle is near the cervix the 
drawing down of the uterus gives no trouble, as upon the 
severance of the pedicle the organ is spontaneously replaced 
through the influence of atmospheric pressure, and the elas- 
ticity of the connective tissues put upon the stretch when 
the womb is forcibly drawn down. The wire ecraseur is 
recommended by some authors as less likely to break than 
the chain; but I much prefer the chain, as there is less dan- 
ger of hemorrhage with its use, and with care and skill 
a chain is seldom broken. Formerly ligature was employed, 
using it singly if the pedicle was not very large, and double 
if large — i. e., transfixing the pedicle with a needle armed 
with a double ligature, and tying one on either side, and 
then cutting off the pedicle a short distance from the liga- 
ture; of course, between it and the body of the polypus. 
Others leave the polypus to drop off when the ligature has 
caused a sufficient slough to enable it to do so. Others 
have applied a ligature around the pedicle, and passed the 
ends through a double canula, and tightened them daily as 
they became loose from the cutting into the pedicle of the 
loop around it. 

Objections to the Ligature. — -The use of the ligature is 
open to the following objections: 1st. it is unnecessary; 
2nd. It is more liable to give rise to hemorrhage than when 
the pedicle is severed with the chain ecraseur; 3rd. It is 



368 EA TON ON DISEASES OE WOMEN. 

more liable to cause inflammation; 4th. It is tedious, and 
causes offensive and irritating discharges, which are mostly 
avoided in removal with the ecraseur; 5th. The proper use 
of the ligature requires more skill, unless the tumor is small 
and can be drawn out of the vagina, in which case, it is bet- 
ter to remove the polypus at once, in our opinion, than to 
ligate it, and be troubled with the slough for some time after- 
wards; 6th. In polypi with large pedicles they are usually 
so short, that there is not room to cut off the tumor, without 
loosening the ligature, which might give rise to alarming, if 
not dangerous hemorrhage, while in the use of the chain ecra- 
seur, the tissues are crushed off, and the shreds of the torn 
blood vessels arrest the flow of blood, and the lacerating 
process as produced by the use of the ecraseur is well known 
to be little likely to cause hemorrhage. I have never had 
troublesome hemorrhage from the use of the ecraseur in the 
removal of fibrous uterine polypi, though I have removed a 
great number in this manner. And I believe this is the expe- 
rience of all others who use the instrument. 

Anaesthetics. — The use of anaesthetics is not generally 
necessary in the removal of either variety of uterine polypi, 
except in some cases of exceedingly nervous women, who 
suffer so much from fear,' that it is better to give them an 
anaesthetic. In a few cases this is desirable during the use 
of sponge tents on account of the suffering induced by their 
dilatation ; but this is not usually the case, as the expansion 
of the tent does not, as a rule, produce severe pain. The 
fibrous polypus being destitute of nerves, the severing of the 
pedicle with the ecraseur gives little or no pain, even when it 
is of large size. 

Various kinds of Treatment under various Circum- 
stances. — Sometimes after we have severed the pedicle in the 
uterus the tumor is not readily extracted through the os, and 
it may become necessary to seize the tumor with the vulsettwn 
forceps and incise it freely in order to extract it. This is not, 



UTERINE POL YPI. 369 

however, absolutely necessary, for if we wait a few days 
uterine contractions will come on and expel the polypus, which 
is lying loose in the uterine cavity. 

Sometimes the tumor is so large as to distend the vagina 
severely, and it may become necessary to relax the os vaginam 
with Bell, ointment and the inhalation of Chloroform, while we 
extract the tumor with the ordinary obstetrical forceps. 

In case we dilate the os uteri fully, and find the polypus 
attached to the fundus by a broad, short pedicle, what is to be 
done? First, Ave may attempt to pass the chain of the ecra- 
seur around it, and for this purpose Edward's ecraseur is the 
best (in our opinion), using Sims' guide to raise the chain into 




Fig. No. 40. — Edward's Ecraseur. 

position. Should we fail in adjusting the chain around the 
tumor properly we may incise the polypus and enucleate it 
with the vuUellum forceps, or we may incise it and push into 
the incision with a long probe, or uterine sound, a good sized 
piece of lint, and leave it there several days, to establish sup- 
purative or ulcerative action in the tumor. Or we may insert 
a long sponge tent up by the side of the tumor, and thereby 
excite uterine contractions, and hence exert great pressure 
upon the polypus, which may cut off its supply of blood, and 
strangulate it, causing it to soften and decay, when we may 
take it away piecemeal with the vulsellum forceps, or we may 
allow nature to slough it off. 

To Dr. J. Marion Sims * are we indebted for a knowledge 
of the efficacy of sponge tents in destroying fibroid polypi. 
He accidentally made the discovery by placing a sponge tent 
in the uterus and forgetting it about a week, when, upon the 

* Sims' Uterine Surgery. 
24 



370 



EATON ON DISEASES OF WOMEN. 



removal of the tent the polypus was found destroyed. I have 
proven this to be an efficacious means of destroying those 
fibrous polypi which we could not conveniently remove by 
ordinary operation. I have not left a tent longer 
than thirty-six hours in the uterus ; but upon re- 
moving it I have inserted another (after washing 
out the vagina with injections of warm carbolized 
water), and letting it remain another thirty-six 
hours, and have thus caused the destruction of 
large fibrous polypi, so that I removed them 
piecemeal with the vulsellum forceps. Needles 




Fig. No. 41— Electrolysis Needles. 

charged with electricity have been used to de- 
stroy these polypi, as have injections of Tr. Iron 
or Iodine ; but we deem these measures inferior 
to those previously described. 

After Treatment. — After the polypus has 
been removed, there is usually little treatment 
required beyond giving a nourishing diet and re- 
quiring rest in the recumbent position. Should 
there be great exhaustion China, Ars., Nux, Rhus, Sepia, Fer- 
rum, Ignatia, Phos., or Canthar., may be indicated by the to- 
tality of the symptoms. But the symptoms requiring these 




Fig. No 42. 



UTERINE POL YPI. 371 

remedies are to be considered complications indirectly caused 
by the operation and not the result necessarily of it. I have 
had cases complicated with torpid liver, jaundice, spinal irrita- 
tion, worms in the intestines, etc., which conditions could not 
more than indirectly be dependent' upon the polypus, and not 
in the least upon the operation ; and we do not see the need 
to mention every remedy in the Materia Medica because a 
possible complication might arise demanding their use. 

Treatment of Single Cystic Polypi. 

It is well in the case of the single cystic polypus of the 
uterus to dilate the cervix to the size of the finger, that we 
may more easily ascertain the locality of its attachment. If 
the tumor is ruptured we may ascertain this with the finger; 
if not raptured, we may gently insert the uterine sound (in 
case we are sure, from the symptoms and history of the case, 
that pregnancy does not exist) ; then, after ascertaining the 
location of the pedicle, we rupture the sac and draw it out 
of the cervix with a pair of straight, long uterine dressing 
forceps. Now introduce a Wocher bivalve or a Dawson's 
improved Sims' speculum (see chapter on " Instruments"), 
and bring the membranes of the sac into view. We now 
pass into its interior a long brush or swab saturated with 
Comp. Tr. Iodine diluted with Gbjcerine one-half, having the 
patient lie upon the side to which we have found the tumor 
attached, so that the Iodine may gravitate about the pedicle 
on its interior. After allowing the Iodine to remain about 
an hour, we wash out the sac with warm water, then seize 
hold of the membranes with the forceps, and, after drawing 
them down as far as possible, sever them with long scissors as 
high up in the cervix as we can reach. This process keeps 
the Iodine from direct contact with the uterine tissues, and 
it operates to produce adhesive inflammation in the interior 
of the pedicle. Three cases I have treated in this way have 
proven successful. One case was complicated with retro- 



372 EATON ON DISEASES OF WOMEN. 

flexion. The after treatment is to be conducted upon the 
same principles as in the removal of the fibrous polypus of 
the uterus. 

Treatment of Hydatids of the Uterus. 

The hydatid uterine polypus is to be treated by dilating the 
cervix and breaking up the mass with the finger or the curette. 
Usually when a part is thus broken, the uterus contracts and 
expels the remainder. If it does not we may give Secale cor. 
in doses sufficient to induce contractions, and we may aid their 
production by frictions to the inner surface of the uterus with 
the finger. After their expulsion we swab out the interior of 
the uterus with Comp. Tr. Iodine diluted with Glycerine five 
times, or Argent. Nit., five grs. to the oz., laying the patient 
upon the side to which the pedicle was attached. This ap- 
plication may be repeated two or three times at intervals of 
two days. 

Treatment of Vascular Uterine Polypi. 

This polypus, which is very rare and bleeds from its own 
surface (being largely supplied with blood-vessels), is really an 
enlarged glandular polypus, whose covering (the mucous mem- 
brane) has through inflammatory action developed large blood- 
vessels over its surface, and requires ligation. It is usually 
soft, and may be drawn out with forceps, and ligated after 
dilating the cervix with sponge tents. Before the ligature is 
applied, we should twist the tumor several times around, that 
the blood-vessels of the pedicle may be made as tortuous as 
possible. 

The ligature may be most conveniently applied by means 
of the double canula, but we should not tighten it too much. 
The ligature should be just tight enough to strangulate the 
pedicle, without cutting into it. Every two days the ligature 
should be tightened, till a slough is caused, and the tumor 
becomes detached; after which the case is to be treated with 



UTERINE POLYPI. 373 

homoeopathic remedies, according to the total indications. 
Warm ivater vaginal injections are always in order, after the 
removal of either variety of uterine polypi. 

Treatment of Mucous Polypi of the Cervix and Vegetations of 

the Endometrium. 

The general principles of treatment of these varieties of 
polypi are the same. 

Ipecac, Aconite, Nux, Ferrum, etc., are often indicated. 
Usually patients affected with these small polypi do not 
have such an excessive and alarming hemorrhage as in in- 
stances of the larger varieties, although in exceptional cases 
the hemorrhage is great from very small polypi. 

Should there be very free hemorrhage, no time should be 
lost before we introduce the sponge tent, and we should se- 
lect the size which will fill the cervical canal before it begins 
to expand, so that as it expands it will exert a decided press- 
ure upon the growths situated in the cervical canal ; this com- 
presses the pedicles of those hanging out of the cervix, and 
arrests the flow from those above the neck of the organ. The 
tent should be dipped into carholizecl olive oil before it is in- 
serted. After using the tent, any small polypi hanging from 
the cervical canal may be removed by torsion. 

After obtaining a dilatation as large as the finger, we 
should ascertain by digital examination whether or not there 
are any growths in the uterus above the cervix; for this pur- 
pose we may draw down the uterus with a strong tenaculum, 
and insert the finger to the fundus uteri and thoroughly ex- 
plore its cavity. If we are able to feel any growths in the 
uterine cavity which appear to have slender attachments, we 
may pass up by the side of the finger a slender pair of for- 
ceps, seize the growths, and remove them by torsion. If the 
attachments seem large or if the groAvths are numerous, the 
interior of the uterus should be swabbed thoroughly with Arg. 
Nit. 20 grs. to the oz., or even 30 grs. may be used if a few 



374 EATON ON DISEASES OF WOMEN. 

applications of the 20 gr. solution does not cause the growths 
to drop off in a week or ten days, using the swab every two 
days. (This is the method of treatment I used in the case 
mentioned in general description of uterine polypi repre- 
sented by Fig. No. 36.) 

These large vegetative growths of the body of the uterus, 
of the nature of enlarged mucous polypi, are of rare occur- 
rence. Usually the mucous polypi are confined to the cer- 
vix, and are destroyed by means of the pressure exerted 
by the use of two or three sponge tents. Sometimes only one 
tent is necessary to secure the complete destruction of these 
growths, or of enlarged granulations in the cervical canal. 

This treatment I like much better than the application 
of the solid Nit. of Silver, which has been so extensively 
used. The caustic gives greater danger of atresia following 
its use (closing up the cervical canal, so that impregnation 
is impossible), and in other cases where there is only partial 
closure of the cervix, and pregnancy occurs, the danger of 
laceration of the cervix becomes very great, and the impli- 
cation of the bladder in the laceration is to be feared ; hence, 
caustic applications in the cervical canal should be avoided. 

After we have destroyed the granulations, or mucous 
polypi, of the cervix with the sponge tent, we should daily, 
or every two days, pass a bougie, well oiled with Vaseline, 
till the raw surface from which the polypi have been re- 
moved is well healed, using a vaginal wash of Calendula and 
water daily, and giving such internal remedies as the totality 
of the symptoms demand, with such nourishment as will be 
most easily digested and assimilated. This method of treat- 
ment gives promise of no further trouble by reason of the 
development of neAV granulations, or mucous growths, as by 
these means we secure the development of the healthy 
mucous membrane in the cervix, which if left without this 
care after the use of the tents would probably soon produce 
a new crop of polypi. 



MOLES IN THE UTERUS. 375 



CHAPTER XXVIII. 

MOLES IN THE UTERUS. 

Moles in the uterus, sometimes called molar, or false 
pregnancy, consist of a fleshy mass, to which is attached 
a sac filled with fluid resembling the amniotic liquid. The 
fleshy part of the mole resembles the fleshy part of the 
placenta. Upon rupturing the sac no foetus, or even the 
remains of one, are to be found. Moles develop to various 
sizes, varying from an inch to four or five inches in diameter. 

Etiology. 

Authors speak of blighted conceptions, injuries to the 
patient, etc., as causing moles, but I do not know that any 
of them offer any satisfactory explanation of their causation. 

I have a theory regarding them, which may be correct 
or not; still, as good, perhaps, as any yet advanced. I 
believe they result from the small number of spermatozoa 
which penetrate the ovum. My reason for this idea is, 
that I have found, and I am told by other physicians of large 
experience that they also have observed, that moles most 
frequently develop in those women who take pains to pre- 
vent pregnancy by using a syringe after connection, or in 
cases where the husband withdraws before the ejaculation 
of semen (as he thinks, but probably a small portion is left 
in the vagina, as it is also likely that in some instances 
a small part of the semen is left after using the vaginal 
syringe). I expect that future observations will also show 
that in those cases where these attempts to prevent concep- 
tion are not made the semen will be found to be deficient 
in a normal amount of spermatozoa, and the deficient impreg- 



376 EATON ON DISEASES OF WOMEN. 

nation will be, in most cases, found dependent upon their 
deficiency in numbers or strength. 

We do not know whether or not a single spermatozoon 
is sufficient to impregnate the ovum so as to cause the devel- 
opment of a healthy foetus. I claim that it is not ; neither 
do I believe that a very small number can do it. The 
requisite number I can not at present even approximate, 
but 1 am satisfied it is large. One reason for my belief is to 
be found in the development of moles under the circumstances 
named; and another is from the fact that nature produces 
spermatozoa in such immense numbers ; and it is reasonable 
to suppose that nature does not waste her forces by producing 
thousands when only one is needed. A single ejaculation of 
semen was evidently intended for a single impregnation. 
I do not think it reasonable that nature produces a hundred 
times as much semen at each connection as is adequate to 
produce healthy conception. All the secretions of the body 
are furnished nearly in the amount required for the purposes 
for which they are secreted; never, in health, very greatly 
in excess. Why, then, should we imagine nature made such 
a mistake as to furnish a hundred times as many spermatozoa 
in a single ejaculation of semen as is required to produce 
impregnation ? 

Constriction of the cervical canal tending to prevent the 
free ingress of semen, is also a cause of the production of 
moles by preventing the free ingress of the semen into 
the uterus. 

Diagnosis. 

The diagnosis of a mole in the uterus is sometimes diffi- 
cult. There are present in some cases symptoms indicative 
of pregnancy, the menstruation being entirely suspended, and 
the uterus becoming somewhat enlarged, with the occurrence 
of nausea and enlargement and tenderness of the breasts. 
In other cases there is only partial arrest of menstruation ; 
and in still other cases it is not at all diminished, and in a 



MOLES IN THE UTERUS. 377 

few instances the flow is excessive, and there is more or less 
loss of blood during the interval between the times of the 
regular catamenial flow. The uterus ceases to enlarge in two 
or three months, and the patient complains of faintness, 
weight in the pelvis, pain in the small of the back, etc. 
These symptoms going on for six or eight months, and the 
organ remaining about the size it would be when there was 
a two or three months' pregnancy, give us good reason to 
suspect a mole in the womb, especially if we know the patient 
has been trying to avoid conception. 

Still, these symptoms are not positive evidence of the 
existence of a mole, as there might be a dead foetus remain- 
ing in the uterus causing them, or there might be present 
sub-acute metritis or endo-metritis. These diseases have, 
however, other symptoms which should enable the physician 
to differentiate. 

In other instances the patient has noticed no peculiar 
symptoms (this makes diagnosis more difficult), her com- 
plaints being such as might result from displacement of the 
uterus or from slight pelvic inflammation. I will relate a 
case in illustration. 

Not long since a lady came to me from Illinois suffering, 
as she and her family physician supposed, from retro-flexion 
of the uterus with dysmenorrhoea. Her trouble had been 
of several years' standing, and although married (for ten 
years) and well formed, she stated that she had never been 
pregnant. In about two days after replacing the uterus with 
the sound, which I had great difficulty in introducing, I was 
surprised to be called to her in haste, when I found her suffer- 
ing with symptoms of a threatened miscarriage. She had hard, 
regular uterine contractions, but no hemorrhage. (Her men- 
struation had been regular, though scant and painful, and she 
being very anxious to become a mother, I had not thought 
of the possibility of pregnancy, nor was there a single symp- 
tom in her case to indicate it.) But here were the pains, and 



378 EATON ON DISEASES OE WOMEN. 

I could only diagnose a small uterine tumor of some kind, 
though I had not found any enlargement of the uterus more 
than is common in cases of retro-version. The pains went 
on ; in fact, I did not try to stop them, and my patient was 
soon delivered of a mole, with the sac entire, about as large 
as a very small hen's egg. On opening the sac I found it to 
contain nothing but a liquid resembling the amniotic fluid. 
No vestige of a foetus or placental chord could be discovered, 
though there was the fleshy part resembling a placenta. 

I have delivered, I think, six of these moles in my expe- 
rience of over twenty years, which shows their rarity. All 
of the others were, however, larger than this, but showed 
the same anatomy and appearance. 

Prognosis. 

The prognosis is always favorable. Moles of the uterus 
usually are expelled by the efforts of nature, and there is 
little danger to life if the patient is not imprudent. 

Treatment. 

Upon the subject of treatment little can be said, except 
to give the remedies homoeopathically indicated by the to- 
tality of the symptoms in each case. Usually the positive 
diagnosis of moles in the uterus can not be made, hence we 
are not justified in instituting any operative treatment unless 
sufficient time has elapsed to place conception out of the 
question, or at least make us sure that healthy, normal ges- 
tation is not going on. When this is sure, by the lapse of 
time, and there are any urgent symptoms demanding prompt 
action we may insert the uterine sound and break loose the 
attachments of the mole, as we would separate an adherent 
placenta after abortion, by sweeping it gently around the in- 
ternal surface of the uterine cavity. Uterine contractions 
will then soon come on and expel the mass. 

In case the sac is accidentally ruptured before we see 



MOLES IN THE UTERUS. 379 

the patient, the treatment to be used is the same as if the 
case was one of miscarriage. Uterine contractions are to 
be excited by cold applied to the epigastrium, by irritat- 
ing gently the interior of the cervix with the ringer, by 
giving Secale cor., in doses sufficient to strengthen any feeble 
uterine contractions present. Tampon the vagina with the 
gum elastic bag in case of excessive hemorrhage, and give 
Aconite, if the pulse is rapid and wiry ; Ipecac, if there is nau- 
sea or vomiting; Bell., if there is passive hemorrhage with 
dilatation of the pupils and the rapid soft pulse. 

After the expulsion or delivery of the morbid growth, 
China will usually be indicated if there has been great loss 
of blood, and there is much exhaustion; Ferritin, for the pale 
anaemic countenance; Nux or Phos. ac, when there is loss 
of strength, poor appetite and weakness of nerve force; Ig- 
natia, Bell., or Vend., if there is jactitation of the muscles, 
or a tendency to spasmodic action; Puis., where there has 
long been Amenorrhoea, with weak digestion, and pain in the 
small of the back or ovaries. 

The patient should rest in bed in the horizontal position 
for several days, after the expulsion or artificial delivery of a 
mole, and nourishing, easily assimilated food should be freely 
given. Stimulants, tea and coffee, should be avoided. Cool 
w T ater may be drank quite freely. 



380 EATON ON DISEASES OF WOMEN, 



CHAPTER XXIX. 

CATARRH OF THE UTERUS AND VAGINA. 

Catarrh of the uterus is by many authors discussed as 
endo-metritis. It is true there is some inflammation of the 
lining membrane of the uterus in cases of catarrh of this 
organ. Still there should be a careful selection of terms, so 
as to indicate the state of the case we wish to describe. 

The term catarrh suggests to the^mind the idea of exces- 
sive, offensive discharge from the part affected. The term 
catarrh of the uterus should, in our judgment, be restricted 
to those acute attacks of irritation of the endometrium caused 
from cold, coining on suddenly in women or girls previously 
healthy, and sometimes affecting the whole system at the 
same time. 

The inflammation of the endometrium produced from 
other causes than cold I would term endo-metritis. 

The attack of endo-metritis may be acute; but it is not 
characterized by the free discharge of mucus and muco-pur- 
ulent, or bloody matter, as in cases of catarrh of the uterus, 
or catarrh of the uterus and vagina combined. An inflam- 
mation of the vagina caused from excessive coitus, strong 
vaginal injections, ascarides, the wearing of a vaginal pess- 
ary, or the introduction of irritating substances into the 
vagina, could not properly be termed catarrh of the vag- 
ina; hence Ave see the propriety of restricting the term ca- 
tarrh of the vagina to cases caused from cold, and that the 
term should indicate that the attack was sudden, and that 
there was also a profuse leucorrhoeal discharge at the same 
time. 



CATARRH OF THE UTERUS AND VAGINA. 381 



etiology. 

The main direct cause of catarrh of the uterus or vagina, 
is cold; but there are certain predisposing causes as well. 
The condition of the general system has much to do with the 
liability of the patient to take cold at any time, and the con- 
dition of the uterine organs at times is such as predisposes 
to a cold, when under other conditions the parts would be un- 
affected. Just before the menstrual period for a few days, 
during the flow, or just after its cessation, women are most 
likely to be attacked with catarrh of the uterus and vagina. 
This is due to the heightened nerve sensibility of the parts 
at this period, and, to the congested condition of the capil- 
lary circulation before and during the flow. 

This heightened nerve sensibility in the uterine organs 
produces a sympathetic sensitiveness in the whole nervous 
system. Hence the patient is not only more sensitive to 
cold, but also, to all influences affecting the nervous and cir- 
culatory systems. 

The wearing of thin-soled shoes, and insufficient under- 
clothing; going into the cold, from a warm room, whether it 
be a theatre, church, or room in a private house, without a 
sufficient amount of extra clothing, is a fruitful source of 
cold, which in those persons predisposed to an attack of 
catarrh of the uterus or vagina might develop either or both 
of these diseases. Bathing in cold water, at the menstrual 
period, or in a cold room in cold weather, is also very liable 
to produce these diseases. 

Diagnosis. 

The attack of catarrh of the uterus or vagina is ordin- 
arily characterized in its commencement by the occurrence 
of a chill. This chill sometimes affects the whole body, and 
sometimes is confined mainly to the hips, lower limbs, and 
lower part of the back. This chilliness is often accompan- 



382 EA TON ON DISEASES OF WOMEN. 

ied with nausea. In a period varying from half an hour to 
several hours reaction comes on, and a fever follows. The 
fever is sometimes quite continuous for several days, and 
sometimes comes and goes at irregular intervals. The pa- 
tient complains of weakness and lassitude, often with a dis- 
position to sleep, with pain in the small of the back, and a 
bearing down pain in the pelvis and lower part of the ab- 
domen. 

Within a day or two after the commencement of an at- 
tack of catarrh of the uterus or vagina, or both, there ap- 
pears a profuse slimy greenish or yellowish white vaginal dis- 
charge, which is in some cases mixed with streaks of blood. 
The discharge (if not at first) soon has an offensive odor. The 
patient complains of headache and occasionally has some pain 
in passing urine, w T hich indicates the bladder complication in 
the catarrhal condition. The eyes look blood-shot and watery, 
the pulse is rapid and wiry. The patient is not inclined to 
walk about. She complains of heat in the vagina, and some 
pain in the uterus. 

A digital vaginal examination reveals heat and tender- 
ness in the vagina. The labia and vulva are sometimes 
swollen. If w r e introduce a vaginal speculum, we see the 
os and cervix as well as the vaginal mucous membrane red, 
and the capillaries congested; and if the catarrh affects the 
uterus, there is a discharge oozing from the os uteri of the 
character before mentioned. The examination with the spec- 
ulum is usually yevy painful, and we may, in most instances, 
omit it. The diagnosis is usually made correctly from the 
history of the patient and the other symptoms enumerated, 
aside from any physical examination of the parts. 

Differential Diagnosis. 

The disease most likely to be confounded with catarrh of 
the vagina, is gonorrhoea. It is sometimes very difficult to 
differentiate between them. Usually the history of the case, 



CATARRH OF THE UTERUS AXD V AG IX A. 383 

and the character, circumstances, and age of the patient aid 
materially. In gonorrhoea, there is commonly more pain in 
passing water, more intense heat in, and more swelling of, 
the labia than in catarrh of the vagina. 

We must, however, bear in mind, in considering the 
history, the age, and character of the patient, that innocent 
persons may have gonorrhoea, The wife may have innocently 
contracted it from her husband ; a vicious domestic may have 
placed some of the gonorrhoeal matter from her own person 
between the labia of a young girl, or she may have purposely 
or accidentally smeared the seat of the water closet with 
this matter. General symptoms of a cold are not present 
in cases of gonorrhoea, and not always, 'tis true, in vaginal 
catarrh. 

The discharge from a case of catarrh of the vagina, 
resulting from cold, may produce inflammation in the urethra, 
and in the glans penis of the husband, and produce such 
a train of symptoms as to make it impossible for the physi- 
cian to distinguish it from ordinary gonorrhoea from impure 
connection. (The same may be said of the leucorrhoeal dis- 
charge, caused from endo-cervicitis or endo-metritis.) Hence 
the physician should be very cautious about disturbing the 
peace of families by deciding a case to be gonorrhoea from 
impure connection, unless he has good evidence to justify 
him, and even then it may be better in most cases to give 
the patient the benefit of any doubt he may have. 

Treatment. 

Aconite is usually the indicated remedy in the com- 
mencement of an attack of catarrh of the vagina or uterus, 
especially if there is dryness and heat of the skin, a rapid 
and wiry pulse, thirst, nausea, etc, 

Bell., when there is dullness and fullness of the head, 
flushed face, and bearing-down pains in the pelvis. 

Bry., if there are sharp stitches in the back, side, or chest. 



384 EA TON ON DISEASES OF WOMEN. 

Sepia, Cat. carb., Can. sat., Cubebs, Copaiva, Cimicif., 
Cantharides, etc., are indicated after the first few days, giv- 
ing them according to the totality of the symptoms. Cubebs, 
Can. hid., Cantharides, or Copaiva are indicated for cutting, 
burning pains in urinating, as is Sepia or Cal. carb., for the 
profuse vaginal discharge. 

Should the disease progress without abatement Ars., 
Sulph., or Rhus tox., are frequently indicated. (See reme- 
dies for leucorrhsea.) 

As adjuncts to the indicated remedies we will mention the 
warm foot bath, warm water vaginal injections, and the warm 
sitz bath, used daily or twice a day. The patient should 
abstain from exercise, and recline a great part of the time. 
Large quantities of cool water should be drank. The food 
should be gentle, bland, and non-stimulating. 



HERXIA OF THE OVARY. 385 



CHAPTER XXX. 

HERNIA OF THE OVARY— HERXIA OF THE UTERUS, OR 
HYSTEROCELE. 

Hernia of the uterus (Hysterocele) is very rare, as is also 
hernia of the ovary. In hernia of the ovary, the uterus is 
displaced also, but does not pass through the inguinal ring. 
The uterus may pass into the crural ring, producing crural 
hernia of the uterus, but I can find but two cases on record. 
One was congenital, the other in a woman aged eighty-two 
years. The uterus is irreducible in these cases, and I men- 
tion this condition simply to record the possibility of its 
occurrence. 

Hernia of the ovary is more frequent. It is most fre- 
quently found as an inguinal hernia. This occurs as a result 
of the formation of a jwocessus vaginalis peritonwi, like that 
in the male, and directs the ovary into the labia. 

Just how frequently this displacement occurs it is impos- 
sible to tell, as the descriptions given by writers do not 
clearly indicate (in many instances) whether the inguinal 
hernia mentioned by them in connection with, and synono- 
mous of, hernia of the ovary, were in all cases really hernia of 
the ovary. Englisch, for instance, is reported by Schroeder* 
as finding nine cases of double inguinal hernia in a total of 
twenty-seven cases. Neither Englisch nor Schroeder say plainly 
that these Avere cases of hernia of the ovary, although they are 
mentioned under the head of inguinal hernia of the ovary; 
and the presumption is that they were of this class. ' 

In cases where the patient has had an inguinal hernia of 

the bowels previous to gestation, hernia of the ovary is liable 

to come on during labor. 

* Ziemssen's Cyclopaedia, Vol. X, p. 355. 
25 



386 EATON ON DISEASES OF WOMEN. 

Hernia of the ovary may be congenital. In this case 
the condition is somewhat the analogue of that in the male 
when the testicle is retained in the abdomen. Crural, abdom- 
inal, vaginal, and ischiatic hernia of the ovary are occasionally 
found to exist. 

Diagnosis. 

The symptoms of inguinal hernia of the ovary are pain, 
heat, swelling, etc., in the inguinal region. On examination 
a hard tumor is felt, like an enlarged inguinal gland, for which 
it is very liable to be mistaken. The tumor is pear-shaped, 
and of about the size of a hen's egg. General symptoms of 
inflammation are sometimes present, but not always. Vaginal 
hernia of the ovary takes place after a rent is made in the 
vagina from severe labor. The ovary is, of course, dis- 
covered in the vagina by physical exploration. Abdominal 
hernia of the ovary can not be diagnosed during life. 

Differential Diagnosis. 

Hernia of the ovary is liable to be confounded with hernia 
of the bowel, and with enlargement of an inguinal gland. In 
hernia of the bowel, the tumor is softer and usually larger 
than in hernia of the ovary. When there is hernia of the 
ovary, the tumor usually enlarges just before the menstrual 
period, which, of course, is not the case in glandular enlarge- 
ment. By passing a sound into the uterus, and moving the 
organ, or moving it with the finger in the vagina, we feel the 
tumor move at the same time, if it be a hernia of the ovary, 
which would not be the case if it was a hernia of the bowel 
or an enlarged inguinal gland. 

Prognosis. 

The prognosis of the hernia of the ovary must depend 
upon the age of the 'patient and the possibility of its reduc- 
tion. If it can be reduced, there is little danger to be appre- 
hended. In quite old women the prognosis is more favorable 



HERNIA OF THE OVARY. 387 

than in the young or middle aged. In the latter classes there 
is greater liability to inflammation in the tumor; in fact, 
inflammation is almost sure to occur sooner or later. The 
inflammation may result in resolution, suppuration, or undergo 
cystic degeneration. Cancer of the tumor has also been de- 
veloped in these cases in a few instances. 

Treatment. 

In cases of congenital hernia of the ovary while the girl 
is young nothing is to be done; in fact, the displacement is 
seldom discovered in girlhood. As puberty comes on, and 
we find we can not reduce the displacement of the organ by 
taxis, it is best to wear a cup-shaped shield, to protect the 
tumor from injury. 

If there is much tenderness, cloths wet with Tr. Aconite, 
one part to four parts of water should be applied warm, and 
the same remedy in attenuation given internally. The reduc- 
tion of the hernia is out of the question in those cases which 
are congenital; hence it is best that remedies be used to sub- 
due as much as possible the normal activity of the circulation, 
consequent upon the process of ovulation. These remedies are 
the Bromides and Camphor. These remedies should be given 
in attenuations sufficiently low to produce the desired effect, 
and marriage should be forbidden. The sexual passion should 
never be excited in these cases. Seclusion is the best for 
girls so afflicted. 

In those instances where hernia of the ovary comes on 
during labor, an effort should be at once made to replace the 
organ by taxis, using those means taught in works on sur- 
gery for the reduction of inguinal hernia of the intestines. 
Taxis failing, resort should be had to the shield to protect 
the organ from external injury, and the remedies already 
mentioned should be given, and sexual congress interdicted. 

In cases where the pain is intolerable the ordinary oper- 
ation for strangulated hernia of the bowels may be per- 



388 EATON ON DISEASES OF WOMEN. 

formed. After opening the sac of the hernial tumor, if it be 
found impossible to return the ovary into the abdomen, we 
may ligate the ligament of the ovary and the vessels sur- 
rounding it with catgut ligature, and remove the ovary with 
the knife. We may then pass the pedicle back into the 
abdomen if it can be easily done, or we may leave it in the 
inguinal canal, closing the incision in the integument by inter- 
rupted suture and adhesive plaster, and dress with Calendula 
wash applied warm, using one part of Tr. Calendula to three 
parts of water. Arnica should be given internally. This 
operation is a grave one, and is not to be performed except in 
cases of great urgency. Holmes* Guersant,f and Englisch% 
operated with fatal results. Pott,|| Lassus,§ Meadows,][ 
M'Cluer,** Deneux,ff and Barnes JJ have operated suc- 
cessfully. || || 

In crural hernia of the ovary the same principles of treat- 
ment govern as in the inguinal variety. The displacement in 
ischiatic hernia of the ovary is of secondary importance 
should suppuration take place. 

In cases of inguinal or crural hernia of the ovary, with 
suppuration, the pus should be aspirated, and the sac injected 
with Dilute Conip. Tr. Iodine, which should also be aspirated 
from the sac in about fifteen minutes, and pressure with com- 
presses applied as firmly as possible. 

In cystic degeneration, the ovary should be removed by 
operation as before mentioned. 

Vaginal hernia of the ovary is to be treated by replacing 
the organ and stitching together the sides of the rent in the 
vagina in a similar manner as is done in cases of vesico- 
vaginal fistula, freshening the edges of the laceration, if it is 
not recent. 

* London Lancet, January, 1864. t Bull de Therap., 1865, page 28. % Ibid., 
page 340. || (Euvres Chir., T. I, page 492. \ Pathol. Chir., Paris, 1806, II, page 98. 
\ Trans. London Obs. Soc'y, III, page 438. ** Ibid, ttlbid. %% Ziemssen's Cy- 
clopaedia, Vol. X, page 357. |||| Barnes' Diseases of Women, page 267. 



Plate XVI. 




CYSTOCELE. 



PROLAPSE OF THE VAGINA. 389 



CHAPTER XXXL 

PROLAPSE OF THE VAGINA, CYSTOCELE, RECTOCELE, ENTER- 
OCELE, AND OVARIOCELE. 

The vagina may prolapse in part or wholly. When the 
anterior wall is prolapsed, and the bladder is prolapsed with 
it, it is termed cystocele. (See Plate No. XVII.) When there 
is prolapse of the posterior wall only, and the prolapsed por- 
tion contains the rectum, it is termed rectocele. If the pro- 
lapsed portion contains a portion of the small intestines, it 
is termed enterocele ; and the name i ovariocele is given when 
the ovary is contained in the prolapsed vagina. 

In speaking of prolapse of the vagina, it is understood 
that it is the lower portion which protrudes beyond the os 
vaginam, and has no reference to the inversion of the tube, 
which takes place in procidentia uteri. In ovariocele there is 
probably always present a lateral displacement of the uterus 
at the same time. Enterocele has been thought by some an 
impossibility in this locality, but Fehling* has reported a 
case in which "the patient, in attempting to replace the 
large prolapse of the vagina, ruptured the posterior vaginal 
Avail at the posterior cul de sac, and died in consequence of 
the protrusion of the intestine, which could not be reduced." 
This case shows the possibility of such a dilatation and pro- 
lapse of Douglas cul de sac as to allow of vaginal enterocele. 

Women are not liable to any form of prolapse of the va- 
gina before being delivered of a child. 

Etiology. 

Severe straining during labor while the head of the child 
is partially within the vagina, and while the vagina is not 

* Ziemssen's Cyclopaedia, Vol. X, p. 504 ; also in Arch. f. Gyn., B. VI, p. 103. 



390 EATON ON DISEASES OF WOMEN. 

fully relaxed, tends to produce this difficulty. The head of 
the child may be impacted in the vagina, and in this state of 
affairs the pains of labor are calculated to tear loose the attach- 
ments of the vagina, or carry it down as the head advances, 
and with it the bladder or rectum, or both; and sometimes 
the uterus and some of the small intestines are pressed down 
to the vaginal outlet. The laceration or stretching of the 
pelvic connective tissue in these circumstances allows of the 
prolapse of the vaginal walls. 

The elongation of the vagina which takes place during 
gestation tends to the giving way of its attachments, and 
predisposes to vaginal prolapse after delivery is accom- 
plished. The relaxed condition of the intestinal supports, 
subsequent to labor, allows of their displacement downwards, 
and tends to produce cystocele, and also allows of the disten- 
sion and relaxation of Douglas' cut de sac and the production 
of enterocele or ovariocele. Rectocele is produced in part by 
constipation, impaction and distension of the rectum, etc., 
causing severe straining at stool. 

Diagnosis. 

The general symptoms of prolapsus of the vagina are 
similar to those in prolapse of the uterus. The patient com- 
plains of a sense of weight in the vagina, of fullness at the 
vaginal outlet, of difficult micturition in case of cystocele, 
and of difficult defecation in case of rectocele. The pro- 
truded mass may be felt or seen. In rectocele we are able 
to pass a curved male sound into the anus and around for- 
wards into the dilated and prolapsed rectum forming the 
bulk of the tumor. 

By emptying the rectum, we may discover the contents 
of the prolapse of the vagina to be the ovary (if it be there), 
by pressing the tumor between four fingers, placing two in 
the rectum and two in the vagina. In this manner we make 
out the presence of the ovary by its hard, egg-like feel; 



PROLAPSE OF THE VAGINA. 391 

likewise if the case be enterocele, we feel the intestine, like 
a small, half-filled link of sausage, rolling between the rectal 
and vaginal wall. 

If we suspect cystocele we should pass a male catheter 
into the bladder, and if it drains the protruded mass, and the 
end of the instrument can be felt in it, Ave diagnose cystocele. 
If upon emptying the bladder freely the anterior prolapse of 
the vagina remains as large and fluctuating as before, the case 
would be likely to be one of vaginal cyst. I not long since 
had the case of a wealthy lady of this city who had what 
appeared to be a cystocele. On passing into the bladder an 
ordinary uterine sound it curved backwards, and appeared to 
enter the sac within the prolapsed anterior wall of the 
vagina; but upon passing the catheter, and evacuating all 
the urine, the protrusion was found as large as ever, which 
showed the case 




to be one of vag- 
inal cyst, and 
was proven to 
be one by my FlG - No - 43.-Trocar. 

passing a trocar into the sac, and evacuating it in this way, 
and finding the contents of the sac to consist of a thick, oily 
fluid, much like the white of a raw egg. 

Treatment. 

The principles of treatment of prolapse of the vagina are 
in some respects similar to prolapse of the uterus. There 
is a necessity in both classes of cases for taking off the weight 
of the intestines. This can be accomplished by position (lying 
with the body lower than the pelvis) , or by means of a properly 
adjusted abdominal supporter. (See Plate XII.) In replac- 
ing a cystocele, or either variety of prolapse of the vagina, 
the knee-elbow position is the most favorable, so that we 
have gravity to assist us. 

In cases of rectocele the impacted feces must first be 



392 EA TON ON DISEASES OF WOMEN. 

removed. For this purpose it is sometimes necessary to use 
a scoop. After removing all the accumulation of feces wash 
out the rectum with cool water, and proceed to reduce the 
prolapse of the rectum and vagina by gentle, steady pressure 
upon the mass, after smearing it well with Vaseline. 

When the replacement is accomplished we insert at once 
into the vagina a large sized gum elastic bag, and inflate it 
fully, so as to press the posterior wall of the vagina well up 
into the hollow of the sacrum, and this will also carry up 
any intestinal prolapse which may have occurred, as well 
as lift the uterus as high as possible, and thereby lift up the 
vagina in consequence of its attachment to the uterus. This 
condition of affairs should be maintained for three or four 
weeks, during which time the rubber bag should be removed, 
washed, and replaced every four or five days. The bowels 
should be moved by means of warm water enemse daily, 
always injecting a small quantity of cool water into the 
rectum after the stool, which may be allowed to remain in 
the bowels till the next day. 

After four weeks of trial of this treatment we would 
advise leaving out the inflatable rubber bag for a few days 
(but still wearing the abdominal supporter), and see if the pro- 
lapse of the vagina returned. If it did not, the patient may 
be dismissed with the injunction to be careful not to lift 
hard, or strain in any way, using an enema of w T arm soap 
and water if the bowels do not move readily and regularly. 
If we found the prolapse returned partially or completely 
we would repeat the treatment for another four weeks. At 
the end of this time, if the case is not cured, it may be 
advisable to resort to an operation, called elytrorrhaphy, to 
remove the superfluous tissue from the vagina. This, how- 
ever, should not be done till all other means have failed. 

During the treatment above mentioned remedies should 
also be used calculated to build up the system. The follow- 
ing remedies are indicated most frequently by the symptoms : 



PROLAPSE OF THE VAGINA. 393 

Ars.y Bry., Rims, Nux, Bell., Secede, Cantharides, Can. incl., 
Col. carb., Ferrum., China, Sepia, and Kreosotum. Bathing the 
parts with cold water, and keeping the bladder and rectum 
empty, must never be neglected in these cases. 

Elytrorrhaphy consists of incising and removing a piece 
of vaginal tissue, so that when the opposite sides of the 
vagina are brought into apposition by sutures, and adhesion 
results, the size of the vagina will be materially lessened. 
The operation is quite similar to that for vaginal fistuloe. 

Operation of Elytrorrhaphy. — All other means failing, if 
the patient and friends desire, Ave may resort to the operation 
for lessening the size of the vagina, called elytrorrhaphy. In 
deciding upon an operation we should bear in mind the ob- 
struction which the contracted vagina is liable to offer to 
delivery, in case of future pregnancy. Of course, if the 
patient is a widow not contemplating marriage, or if she has 
passed the child-bearing age, this objection does not stand. 
The piece of vaginal membrane removed should be from the 
posterior wall in cases of rectoccle, cnterocele, or ovariocele ; and 
from the anterior wall in cases of cystocele. The piece of 
membrane removed should be diamond shaped. 

The patient should lie upon her right side upon the oper- 
ating table, with the thighs well flexed in operating on the 
posterior wall, and on the left side to reach the anterior wall. 
Complete anaesthesia should then be induced, and the keep- 
ing up of the effect be intrusted to a reliable assistant. 
Another assistant dilates the vagina with Dawson's improved 
Sims' speculum, so as to bring the wall of the vagina we wish 
to remove distinctly into view. We now map out the piece 
we desire to remove by touching the membrane of the vagina 
with the edge of the scalpel on the lines we wish to incise. 
We next hook up the vaginal membrane, and making it a 
little more tense, make the incision complete upon the upper 
side of the diamond-shaped piece; seize this membrane now 
where it is incised, and carefully dissect it off the diamond- 



394 EATON ON DISEASES OF WOMEN. 

shaped piece to be removed, then cut off the piece we have 
dissected up. 

We next place interrupted sutures, as in operating for 
recto- or vesico-vaginal fistula, placing the one nearest the 
uterus first. We use silver wire for the sutures, and twist 
them with our wire holder and twister. (See chapter on " In- 
struments," Plate VI.) The sutures should be placed about 
one-third of an inch apart. After the sutures are placed the 
patient should be carried to bed, and allowed to come out 
from the influence of the anaesthetic. The sutures may as 
well remain about two weeks. In removing the sutures the 
physician should be very gentle about it, so as to disturb the 
parts as little as possible. 

Professor Beebe, of Chicago (now dead), used to recom- 
mend the removal of a circular piece of vaginal membrane ; 
but before his death he stated in the Illinois Stale Society that 
he agreed with me in the advisability of removing a diamond- 
shaped piece instead. 



PAPILLARY TUMORS OF THE UTERUS AND OVARIES. 395 



CHAPTER XXXII. 

PAPILLARY TUMORS OF THE UTERUS AND OVARIES, AND 
COCCYGODYNIA. 

Papillary tumors of the ovaries are seldom met with, 
and demand no more than a mere mention, their development 
being a bare possibility, and their diagnosis ante-mortem 
being an impossibility. Ascites and rupture of the umbilicus 
were found by Eberth and Gusserow* to be dependent upon 
these papillary growths of the ovary; just how, I can not 
understand. 

Papillary tumors of the uterus are so designated by a few 
authors. They ordinarily consist of enlargement of the pa- 
pillae of the organ from irritation long continued, as in chronic 
sub-acute inflammation. They sometimes take on ulcerative 
action, and have developed into malignant diseases in some 
instances. They ordinarily produce hemorrhage on being 
touched even slightly. The other variety of papillary tumors 
of the uterus are really condylomata, are pointed, and result 
from syphilitic contamination. Schroederf says from gon- 
orrheal matter, but I have never seen gonorrheal contamin- 
ation cause condylomata of the uterus. These condylomata 
are usually found in connection with the same development 
in the vagina, or upon the external genital organs. These 
growths sometimes coalesce so as to give somewhat the ap- 
pearance of the cauliflower excrescence, for which they have 
been mistaken. 

Symptoms. 

Generally there is a profuse leucorrhoeal discharge in 
these cases, or a profuse watery flow, sometimes mingled 
with blood, passes from the vagina. 

* Ziemssen's Cyclopaedia, Vol. X, p. 442. tlb., p. 269. 



396 EATON ON DISEASES OF WOMEN. 

Treatment. 

The treatment of papilloma of the uterus of the variety 
first described consists in the introduction into the cervical 
canal of a sponge tent well carbolized. This exerts steady 
pressure upon these tumors and the capillary circulation is 
restrained by it. The tent may remain twelve hours, and be 
followed by another. Tr. Iodine Comp. may be applied to 
those external to the os uteri. Remedies such as are indi- 
cated homoeopathically by the general symptoms should be 
given. In the condylomatous variety Kali iod. and Merc, cor., 
are indicated. They may be ligated and cut off with scissors, 
if few and long; or, if large, may be severed with the 
ecraseur. Thuja, Acid nit., etc., are often indicated in this 
disease. 

COCCYGODYNIA. 

To Sir James Simpson is due the honor of having first fully 
explained this disease, and proposed efficient means of treat- 
ment, though Dr. J. C. Knott, of New York, published short 
reports of two cases in the New Orleans Medical Journal fif- 
teen years before. Previous to Professor Simpson's publica- 
tion of his work on u Diseases of Women," pain in the region 
of the coccyx was supposed to be neuralgia purely. It is now 
known to be, in many instances, due to inflammatory action, 
and in some cases there is dislocation of the whole coccyx or 
some of its pieces. 

Etiology. 

The difficulty is due in some cases to direct violence, as in 
a fall or from a blow; in others from injury received from the 
passage of the head of the child through the pelvis in labor, 
bending the coccyx backwards, causing dislocation (or fracture 
in case of the anchylosed condition of the coccygeal bones) or 
lacerating the ligaments which hold the bones together or unite 
the coccyx to the sacrum; or the glandula coccygea may be 



CO CC YG OD YNIA. 397 

injured in labor, and cause severe pain at this point, and even 
an abscess may follow this inflammatory action. This disease 
may also result from sympathy with disease in other parts or 
be the result of reflex nerve action. Notably among these may 
be mentioned almost all uterine and ovarian diseases and dis- 
placements. Dr. Barnes has also seen it caused from fissure 
of the anus. The pain is sometimes in part due to the condi- 
tion of the general system, where there is abnormal sensi- 
tiveness of the entire nervous system, aggravated in this par- 
ticular locality by slightly exciting causes. 

Diagnosis. 

The patient complains of pain in the extremity of the 
spine. It gives her pain to sit; she has to sit sideways. 
Has to change her position often. The pain runs down the 
limbs and sometimes up the back. Defecation is painful, espe- 
cially if there is constipation. Copulation is sometimes pain- 
ful. When there is a partial dislocation of the coccyx or a 
fracture of its parts, in cases where the bones have become 
anchylosed, pressure upon the bone with the finger in the 
vagina or rectum, also causes increased pain. The pain in 
some of these cases in the region of the coccyx is truly piti- 
able, and ordinary treatment for neuralgia is of little or no 
avail, and the patient comes under our care after having be- 
come almost discouraged at the failure of relief she has hoped 
to obtain so often, and as often been disappointed. The 
natural results of great pain long endured, are usually pre- 
sent. The appetite, digestion, nutrition, etc., are impaired. 
The nervous system is shattered, and altogether the case is 
one calling for sympathy and prompt relief. 

Treatment. 

The first thing to do in the treatment of a case of coccy- 
godynia is to ascertain its cause. If there is present displace- 
ment or disease of the uterus, or ovaries, or fissure of the anus, 



398 EATON ON DISEASES OF WOMEN. 

these conditions should be treated at once, hoping that the 
coccygodynia is dependent upon reflex nerve action, and that 
by relieving the ailments upon which it seems to depend we 
may at the same time relieve the coccygodynia itself. While 
treating the displacement of the uterus, or ovaries, or diseases 
of these organs, or the vagina or rectum, remedies should be 
used according to the totality of the symptoms which homceo- 
pathically indicate them. Among the following remedies 
will usually be found the one indicated : Aconite, China, Ars., 
Merc, Ignatia, Nux, Coloeynthis, Colchm., Rhus tox., Lye., 
Bry., Thuja, Sulph. 

Failing in relief from the means suggested, we may make 
a subcutaneous incision over the point of the coccyx and 
insert a tenotomy knife by the side of the bone, and divide 
the tendonous and muscular attachments all around it; or we 
may make a larger incision and extirpate the entire coccyx, 
or the part broken off, in case it be fractured. Where the 
bone stands in against the rectum, at almost a right angle to 
the sacrum, extirpation is the advisable operation. Dr. J. C. 
Knott prefers extirpation to the subcutaneous division of its 
attachments in all cases requiring any operation. Simpson 
also recommends extirpation when the division of the muscular 
and tendonous attachments fails of giving relief. When the 
division of the tissues is thorough, the small nerve twigs 
which supply Luskas gland (the glandula coccygea), are 
severed, and this may explain the relief afforded in some 
instances by the operation. 

The operation (whichever is performed) is comparatively 
simple, and free from danger; still the student should recol- 
lect that it is a last resort. 

I have recently treated a case sent me from Indiana 
which had suffered severely from coccygodynia for over a 
year. I found at once that the patient had prolapsus 
uteri, the os resting against the rectum, with the fundus 
partially ante-verted. I replaced the uterus, and in two days 



COCC YG OD YNIA. 399 

the coccygodynia had disappeared. Her physicians had over- 
looked the cause of the pain, and had thought it to be in the 
rectum or coccyx. My error would have been mortifying 
had I proceeded to divide the attachments of the bone or 
extirpate it. Sitting in this case was extremely painful, and 
defecation she described as almost death. She declared that 
her genital organs were all right, and she believed her trouble 
to be piles. By paying no attention to her opinion, and at 
once making a thorough physical examination, I was able to 
make a more correct diagnosis and relieve her at once; and 
I was informed several months afterwards that the relief was 
permanent. The treatment is often made easy by first mak- 
ing a correct diagnosis. 



400 EATON ON DISEASES OE WOMEN. 



CHAPTER XXXIII. 

CANCER AND CAULIFLOWER EXCRESCENCE OF THE UTERUS— 
CARCINOMA — SAR COMA, ETC. 

We have two varieties of cancer of the uterus, the scir- 
rhous and the encephaloid, the former being much the more 
frequent. The cauliflower excrescence, called carcinoma by 
some authors, is a fungus caused often from syphilis, and ex- 
erts some influence upon the general health by reason of 
the sanguinolent discharge accompanying it. The fact of 
its removal proving curative seems to disprove its cancerous 
character. The disease was first accurately described by Dr. 
John Clark, of London. It is rarely met with in America. 
It springs from the mouth and cervix of the uterus. The 
structure of cauliflower excrescence is fungoid, rough, granu- 
lated, and bleeds easily, being very vascular. It is of a pale 
flesh color. 

Scirrhus of the uterus is most common in women who 
have borne children, according to statistics by Glatter.* Out 
of one thousand Vienna women affected with cancer of the 
uterus, there were 

Single 229 

Widows 268 

Married 503 

1,000 

Prostitutes show no special tendency to carcinoma, as 
might be expected from the nature of their habits. 

The cervix is usually the seat of cancerous disease in 
the uterus. It sometimes extends to the body of the or- 
gan, and very rarely commences in the body of the uterus. 
*Zienissen's Cyclopaedia, Vol. X, page 275. 



CANCER OF THE UTERUS. 401 

It commences with induration of the lips of the cervix, 
which feel tender, hard, and irregular, and bleed easily. 
The lips of the mouth of the womb are everted usually. 
After a time ulceration sets in and causes an offensive sani- 
ous, watery, irritating discharge from the vagina, which ex- 
coriates all the parts with which it comes in contact. 

The encephahid variety of the disease generally occurs in 
the form of soft, lobulated masses which contain clots of 
fibrin. They vary in size from an orange to a child's head. 

Symptoms. 

The symptoms of carcinoma are those of other tumors of 
the uterus, with the excessive and almost constant hemor- 
rhage which we have in non-malignant growths of the uterus, 
but the nauseous, sickening odor of the cancerous tumor 
when it reaches the stage of ulceration is distinctive, as is 
also the cancerous cachexia. 

In the commencement of the growth of a cancerous tumor 
it may be impossible to diagnose it from fibroma of the neck, 
especially when it only affects one lip ; but soon its greater 
readiness to bleed and the bad smelling discharge will indi- 
cate its character. In carcinoma of the body of the uterus, 
affecting the mucous surface, we have the bad smelling dis- 
charge per vaginam, accompanied with almost continuous 
hemorrhage, the introduction of the sound producing great 
increase of the flow of blood. The os may for a time in 
these cases remain quite normal in size and appearance. 

It is usual that the patient dies within twelve or fifteen 
months after ulceration is developed; and before death the 
disease sometimes extends to the neighboring organs, pro- 
ducing utero-vesical, or utero-rectal fistula, but more fre- 
quently exhausts the patient before the disease extends 
so far. The distinctive pains of cancer are sharp and lan- 
cinating. They occur mostly at night, and very seldom by 
day. Why this is so we can offer no explanation. 

26 



402 EATON ON DISEASES OF WOMEN. 



Treatment. 

In cauliflower excrescence we may hope for permanent re- 
lief from amputating the fungus, in connection with a part of the 
cervix uteri, unless there are great complications in the case. 

The treatment of carcinoma of the body of the uterus 
must be mostly palliative, unless we extirpate the uterus. 
No remedy is known that will cure the disease. I have 
more faith in the beneficial effect of Phytolacca decandra in 
this disease (from my own experience) than any other. 
I have seen it arrest the disease for a year or more; and 
in cancer of the breast it has proved so beneficial as to be 
worthy of great confidence, as I know of cases where the 
nodulated tumor of the breast of large size has diminished 
and remained without further development for several years 
after the use of this remedy. The drug acts to purify the 
blood. Conium is perhaps the best remedy we know of to 
relieve the pains of cancer, except it be in those cases 
of extreme, hopeless ulceration which require full allopathic 
doses of Opium or Morphia. In this case I would use the 
opiate for humanity's sake, as I would in case of a hopelessly 
mangled body from external injury, not to cure, but to 
benumb the sensibilities. Palliative remedies are, of course, 
to be used as the various symptoms demand in each individ- 
ual case, with nourishing, easily digested food, and attention 
to all hygienic measures possible. 

Operative Procedure. — No operation short of entire ex- 
tirpation of the uterus is of any avail, and this has not 
often been attempted; and without the patient's urgent 
solicitation it should not be undertaken. I will speak further 
upon this subject while treating of extirpation of the uterus. 

Sarcoma. 

Sarcoma may effect the parenchyma of the uterus, or 
exist as a degeneration of a fibrous polypus. To be brief, 



SARCOMA AXD TUBERCULOSIS OF THE UTERUS. 403 

they resemble uterine fibroma in their symptoms, and are 
not generally discovered to be sarcomatous growths till re- 
moved, or the post mortem reveals their nature. They are 
round, soft tumors, homogeneous in structure, and when cut 
reflect the light uniformly. They are probably always degen- 
erated fibroids. The pedunculated sarcomatous polypus may 
be expelled from the uterus spontaneously. By some it is 
classified as cancerous, but as it does not seem to depend 
upon a depraved condition of the blood, and when thoroughly 
removed does not return, I do not call it malignant. Of 
course, when situated so as to render its removal impossible, 
it may destroy life by reason of ulcerative action, but many 
times this ulcerative action is so long delayed that the patient 
has time to die of some other disease. 

Tuberculosis of the Uterus. 

Tubercular deposits in the uterus take place as they do in 
almost all other parts of the body. They seldom attack this 
organ primarily ; and secondarily only very rarely. The 
symptoms are those of ordinary chronic sub-acute metritis, 
conjoined with the regular tuberculous cachexia. 

Diagnosis. 

The differential diagnosis, in some cases, is very difficult; 
in others, the general tuberculous diathesis, with the history of 
a character such as to suggest a possible hereditary taint, will 
distinguish it from the ordinary sub-acute, chronic metritis. 
There is generally a tendency to amen'orrhoea ; but, in some 
instances, menorrhagia is present, together with the long train 
of sympathetic affections accompanying uterine disease. 

Treatment. 

Those remedies are the most useful which aid activity of 
the glandular system, such as Merc, cor., Protoiodide of Merc, 
Ars., China, Phi/, dec, etc. Good nourishment, especially milk, 
eggs, and sugar, should be given. 



404 EATON ON DISEASES OF WOMEN. 



CHAPTER XXXIV. 

FEMORAL HERNIA, INGUINAL HERNIA, LABIAL HERNIA, VAGINAL 
HERNIA, AND HYDROCELE. 

Labial hernia is of very rare occurrence. Femoral hernia 
is quite frequent ; but is not peculiar to women, though it 
occurs in the female oftener than the male; we will, there- 
fore, refer the reader to works on surgery in regard to femoral 
hernia. 

Inguinal hernia in the female has some peculiarities. 
Although the tumor is usually small, it has been known to 
contain twelve feet of small, and two feet of large intestine. 
When the intestine projects from the inguinal canal into the 
labium, it is termed inguino labial hernia. This form of hernia 
may contain not only intestine and omentum, but the ovary 
and Fallopian tube. The coverings of this hernia consist of 
the skin, superficial fascia, intercolumnar aponeurosis, trans- 
verse fascia, and peritonaeum. The epigastric artery is usually 
on the inner side of the tumor. Labial hernia is usually of 
small size, situated in the inferior half of the labia majora, 
and usually contains a portion of the bladder, though it has 
been known to contain intestine. 

In Vaginal Hernia the anterior form contains the bladder, 
and is termed also cystocele. The posterior form contains 
intestines. Either variety may contain an ovary and the 
Fallopian tube. 

Hydrocele in Women. 

This affection consists of a collection of serous fluid 
around the round ligament. The affection may simulate 
hernia of the inguinal variety. Dr. E. P. Bennett* reports 

* New York Med. Record, Nov. 15, 1870. 



HERNIA AND HYDROCELE IN WOMEN. 405 

a case of this disease in the female. It had been mistaken 
for an inguinal hernia by an eminent surgeon. The tumor 
was about the size of a turkey's egg. The round ligaments 
in the female are analogous to the spermatic cords in the 
male. They end in the labia majora. The peritoneal cover- 
ing usually extends to the inguinal glands; hence, we may 
understand how an irritation around the cord may cause 
effusion in this locality. 

Treatment of Hernia iai Women, 

Vaginal hernia is to be treated by restoring the displaced 
parts or organs by taxis, and retaining them in situ with the 
gum elastic bag in the vagina and the use of the abdominal 
supporter. (See Plate No. XII.) 

In strangulated labial hernia where taxis fails, we cut 
down upon the sac, divide the stricture, and return the 
hernia into the abdomen. 

Inguinal hernia in the female is to be treated as in the 
male, by taxis and the Avearing of a suitable truss. If nec- 
essary to operate, recollect that we have no cremaster mus- 
cle to cut through, as in the male. 

Treatment of Hydrocele. 

When the diagnosis is clearly made the treatment of 
hydrocele consists in aspirating the sac, and then injecting 
into it a ten-grain Solution of Iodine. A small amount only 
of the injection need be used, when it also should be as- 
pirated. We now apply a compress over the seat of the 
tumor, and wait for adhesion of the walls of the sac. If 
it again refills we should again aspirate it, and inject a 
twenty-grain Solution of Iodine, and, after aspirating it, apply 
compression as before. 



406 EA TON ON DISEASES OF WOMEN. 



CHAPTER XXXV. 

hydrometra — pruritus vulvae— abscess of the labia — 
cysts of the vagina — fibroids of the vagina — polypi 
of the vagina— prolapse of the ovaries. 

Hydrometra. 

Hydrometra is worthy of but a word of description and 
comment. It is a term applied to an accumulation of serum 
in the uterus, in cases where there is atresia of the vagina or 
cervix uteri similar to the condition producing haematome- 
tra, the effused fluid being serum instead of blood. This 
condition could not result unless there was an absence of 
normal menstrual flow. It is rarely met with, and is to be 
treated the same as hsematometra. 

Pruritus. 

This term is applied to the itching of the female genital 
organs. The disease is divided into several varieties by 
some authors. 1st, indicating the part affected as pruritus 
of the vagina, pruritus vulvae, etc.; by others it is divided 
according to its imagined causation, as menstrual pruritus, 
when recurring at the menstrual period; climacteric, when 
occurring at the change of life ; pruritus of pregnancy, when 
coming on while the patient is pregnant, etc. 

The disease occasions extreme pain in the attempt to 
suppress the desire to scratch and rub the parts, and when 
the parts are violently scratched or rubbed, the skin and 
mucous membranes are lacerated, or become swollen and in- 
flamed. In some instances the internal surface of the vagina 
is the seat of these severe sensations; in other cases the 
labia, mons veneris, or clitoris, is affected. Sometimes the 



PRURITUS. 407 

itching extends to the thighs upon the inside. The itching 
comes on most frequently at night, and is so severe as to 
prevent sleep. During the day the patient is somewhat 
troubled, and the desire to scratch the parts is so great that 
it almost drives the patient to distraction in some instances. 

Etiology. 

The causes of Pruritus are various. It has usually been 
supposed that the itching of the parts was due to irritating 
vaginal or uterine discharges and inflammation in the parts. 
This is true in very many instances, but we believe that it 
sometimes has its cause in reflex nerve irritation, and some- 
times from congestion of the parts, caused from lack of 
sexual congress, and sometimes from excessive copulation, 
sometimes from onanism, sometimes irritation of the cloth- 
ing, and sometimes from diabetes. 

A large leucorrhoeal discharge does not, as a rule, pro- 
duce pruritus. Neither do acrid uterine or vaginal dis- 
charges invariably cause the disease. Still in some instances 
these discbarges seem to be the cause of the itching. The 
supersensitive condition of the nerves of the entire system 
seems to predispose to the complaint; hence we find that the 
trouble is more common in women who are exhausted either 
by long suffering from uterine or spinal disease, or from 
nursing, in those cases where the difficulty apparently was 
directly caused from irritating vaginal discharges. The reflex 
nerve irritation is shown in cases of amenorrhoea when the 
suppression arises from cold, in cases of metritis, ovaritis, and 
uterine displacements; also occurring at the climacteric 
period and during gestation, although in some of this class 
of cases there is a more or less copious vaginal discharge; 
sometimes, however, there is none observable, and there is 
rather dryness of the parts than moisture. 

Ungratified sexual passion, brought into activity by fond- 
lings and caresses of the lover, in girls of full blood and 



408 EATON ON DISEASES OF WOMEN. 

strong animal nature, by exciting, first, erection of the clitoris, 
and, secondarily, congestion of the adjacent parts, develops 
a violent pruritus, which it is difficult to relieve unless reme- 
dies are given to allay the passionate excitement, or the 
patient marries. Pruritus resulting from excessive coitus 
is due to continuous congestion, irritation, and bruising of 
the parts. 

Onanism, of course, develops a similar, though worse, 
condition, because of the mental and consequent nervous 
disturbance produced. 

The pecliculus pubis or crab, which sometimes infests 
the hair upon the j)ubes, gives rise to similar symptoms as 
ordinary pruritus. Not recollecting this, has caused many 
a physician to lose a patient, because of the failure of his pre- 
scriptions. The second physician consulted, having prescribed 
something to kill the parasites at once, secured the patient 
for the future, as well as earning her lasting gratitude. 

Short stiff hairs upon the labia, situated on its margin, 
may cause the itching. Occasionally girls, for some reason, 
shave off the hair about the privates. As it grows again it 
conies out stiff, and is liable to prick the opposite labium. 

Diagnosis. 

In the diagnosis of pruritus the important thing is to 
determine the cause — the simple description of the complaint 
by the patient is sufficient to enable us to name the difficulty 
as pruritus. Still, to treat it successfully a physical exam- 
ination is sometimes absolutely necessary. The pediculi 
should be carefully looked for. If present they appear 
a little smaller than a pin's head, grayish brown in color. 
They have the appearance of specks of dirt, and adhere 
very tenaciously to the cutaneous surface. When forcibly 
removed they show signs of vigorous life by active move- 
ments. They are circular, and cup-shaped, the outer part 
being about flesh color. Sharp hairs can be readily detected 



PRURITUS. -409 

by the sense of feeling alone. When these conditions are 
not found the aid of the speculum and sound may be needed 
to make the diagnosis of the cause of the trouble. Testing 
the urine for sugar should not be forgotten in these cases. 

Treatment. 

We are justified in some cases in attempting to treat 
pruritus from the descriptions given by the patient, or a 
friend, in order to not shock the modesty of the patient, as 
it is one of the most embarrassing ailments for the patient 
to describe to the physician, unless he has treated her pre- 
viously for uterine ailments. 

First, those things which seem to be aggravating the 
disease should be forbidden, especially scratching or rubbing 
the parts. Smearing the parts well with Vaseline or Olive 
oil for a few days, with the daily use of warm 'water vaginal 
injections, and placing a thin bit of raw cotton between the 
labia, or even pressed up into the vagina, and giving Aconite 
every hour, is commonly a good method to commence on 
when we can not obtain a physical examination, and have 
to prescribe for symptoms ; the Aconite being indicated for 
the feverish, nervous symptoms usually present. 

Treatment of Pediculi. 

When pediculi are found we prescribe 3fercurial ointment, 
diluted one-half with simple Vaseline. This may be perfumed 
as suits the doctor's whim. Let it be applied with the ends 
of the fingers, in small amount, each night for three days, 
washing thoroughly each following morning with castile soap 
and water. Now omit the ointment for about a week; if 
then it is found that any of the parasites remain give them 
another dose of the ointment, applied as before. Sometimes 
an infusion of Tobacco, thoroughly applied to the parts a few 
times, effects a cure by killing the parasites. It should be 
washed off the same as directed after using Merc, ointment. 



410 EATON ON DISEASES OF WOMEN. 

Those cases dependent upon metritis, ovaritis, uterine or 
ovarian disease, or displacement, should be treated by pallia- 
tives till we can remove the cause. First, the parts should 
be frequently bathed with soap and water, and the vagina 
syringed with the same. Follow this with Carbol. ac. one part 
to twenty of water, applying it to the part affected; or, in 
some cases, use Aconite l x as a wash to the parts, keeping the 
labia separated with raw cotton. 

Remedies. 

Remedies must be selected according to the totality of the 
symptoms in each case. Among the following Ave usually 
find the one indicated : Aconite, Nux, Sepia, Sulph., Cat. carb., 
Conium, Arnica, Ars., TJrtica urens, Bryonia, Apis, Puis., Ma- 
crotis, etc. 

When the parts are exceedingly swollen and tender, warm, 
wet, soft cloths are soothing, and a poultice of ground flaxseed 
or slippery elm is sometimes a great relief. Using a wash 
of Kali chlo. ten grs. to the oz. of water is one of the most 
serviceable applications. Strong caustic applications do more 
harm than good. Let them alone. 

In case the cause seems to be ungratified sexual passion 
or onanism, Kali bro., or Camph., in low attenuation, are 
the remedies. Direct a cold sitz bath to be taken daily. 
Bland, unstimulating diet should be given, and plenty of 
exercise in good air should be taken. 

The bowels should be kept regulated with indicated ho- 
moeopathic remedies, and the use of the syringe if necessary. 
The digestive, nutritive, and assimilative functions should be 
noted and kept in as healthy action as possible. 

Abscess of the Labia. 

Phlegmon in the I*abia, etc. 

Phlegmon, or boil in the labia, is somewhat different from 
the disease when located in other parts of the body. In the 



ABSCESS OF THE LABIA. 411 

labia rnajora these gatherings form of small size usually, and 
occur in succession one after another for several weeks or 
even months. 

They are found most frequently in ansemic, debilitated 
women, who are troubled with uterine disease and leucor- 
rhoeal discharges. At first a small pimple is observed on one 
of the labia rnajora, usually upon the inner side. This en- 
larges and inflames till suppuration takes place, which usually 
requires five or six days to accomplish, when the matter 
escapes by ulcerating through the mucous covering. By this 
time others have commenced forming. 

Abscess of the labia sometimes forms from distension of 
Duverney's gland, from obstruction in its duct. It is usually 
observed as a hard lump in the posterior part of the labia in 
the region of this gland, for several weeks, and is not tender 
to the touch for a time ; finally, however, inflammation sets 
in and suppuration follows, unless the nature of the difficulty 
is discovered and proper treatment used before it becomes 
inflamed. 

The more common form of abscess of the labia occurs in 
its center; usually only upon one side, though occasionally in 
both labia at once. In this form of abscess the first thing 
which is observed is swelling and tenderness of the labia. 
On examination the part feels hot and looks inflamed, espe- 
cially on its mucous surface. The patient is scarcely able to 
walk, and can sit with great difficulty. Usually the general 
symptoms indicate fever ; there is a flushed face, rapid pulse, 
and dry skin. These cases often go on for several days 
before the plwsician is notified, and if called he is only 
informed of the feverish symptoms, and, perhaps, told that 
there is a pain in the stomach. (The patient imagining that 
it is proper to say stomach when indicating any point between 
the thighs and breast.) It has been my experience to see 
these cases arise in young married women within a few weeks 
after marriage, or where the husband and wife have been 



412 EATON ON DISEASES OE WOMEN. 

reunited after a long separation, and occasionally in a prosti- 
tute who had recently commenced a life of shame. 

The locality of the trouble, the timidity of the patient 
together make the disease particularly embarrassing. Still in 
some cases it is excruciatingly painful, and something must be 
done. 

The cause of this form of abscess is, doubtless, the bruis- 
ing of the parts by violent copulation in most cases, although 
of course it may arise from bruising in any manner. I have 
seen it arise from bruising the part against the post of the foot 
of a low bedstead. 

This form of abscess of the labia, as a rule, runs a rapid 
course, and within three days from the commencement of 
the attack suppuration takes place. The patient complains 
of a chill, and all the symptoms are more marked, especially 
the fever following the chill. 

Care must be exercised not to mistake a case of inguino- 
labial hernia for abscess of the labia. Here we might have 
the fluctuating feel; but the possibility of partially or com- 
pletely reducing the hernia, would indicate the nature of 
the case. In the inguino-labial hernia, there is swelling and 
pain; but not the heat and redness and disposition to point, 
which there is in labial abscess. In hernia we also frequently 
have vomiting of fecal matter, which we do not see in labial 
abscess. 

Treatment. 

In the treatment of the abscess in the centre of the labia 
from bruising, we usually are not called till pus is formed in 
considerable quantity, and the first thing to do is to evacuate 
it by Tree incision through the mucous surface of the labia. 
The incision has to be deep in some instances to reach the 
pus. When it is reached and evacuated, the patient experi- 
ences very great relief at once. 

Fomentation with hops or poultices of ground slippery- 
elm or flaxseed are to be applied, and such remedies given 



ABSCESS OF THE LABIA. 413 

as seem required. Arnica is usually indicated. If we are 
called before pus has formed, we should apply warm, wet 
cloths, saturated with Arnica and water ; and Arnica, Aconite, 
Bell., or Hamamelis should be given internally, as seem most 
clearly indicated. A warm sitz bath should be used every 
four hours. This plan sometimes aborts the abscess. 

In cases coming on slowly and situated in the posterior 
part of the labia, indicating obstruction in Duverney's gland, 
from closure of its duct, an effort should be made to open the 
duct with a small probe, if possible, in case there is not pres- 
ent very much inflammatory action in the tumor. After we 
get the duct pervious, we should attempt to press out the 
accumulation in the gland; succeeding in this, we may be 
content to simply apply Arnica and water, and give any indi- 
cated remedy. If we can not introduce the probe or evacuate 
the gland, we should apply a warm poultice of flaxseed 
meal or slippery elm, and make another attempt after a day 
or so. Again failing, the poultice should be continued, till 
either the inflammation goes away by resolution, or suppura- 
tion is accomplished, and the pus is evacuated, either by 
ulcerative action, or artificially by the aid of the bistoury. 

Usually in these cases there is a torpid glandular action 
in the entire system, indicating some of the following reme- 
dies : Podoph., Merc, lod., Ars., Hepar, Kali, Sulph., Merc. 
idro., Kux., or Cal. carb. These should be used singly, ac- 
cording to their most prominent homoeopathic indications. 
In phlegmon or boil, the general system must be put in 
order, and usually JSfulph., Kali., idro., Nux, Puis., Ferritin, 
Merc, China, etc., are the indicated remedies. Locally a cloth 
smeared with Vaseline is the most desirable dressing, or raw 
cotton may be substituted for the cloth. Vaginal injections 
of carbolized water should be used twice daily. The condi- 
tion of the stomach and bowels should be especially noticed, 
and such remedies prescribed as the symptoms may homoeo- 
pathically indicate in each particular case. 



414 eaton on diseases of women. 

Cysts of the Vagina. 

Description and Pathological Anatomy, 

Vaginal cysts occur singly in most instances, though oc- 
casionally they are multiple. The walls of the cysts are 
sometimes tough and thick, sometimes thin. The tumor 
produced by the cyst is situated either in the anterior or 
posterior part of the vagina. Sometimes the vaginal cyst 
in the anterior part of the vagina resembles a cystocele 
sometimes it pouches down, so as to appear like a polypus, 
owing to the relaxed condition of the anterior vaginal wall. 
They usually are enlarged follicular glands of the organ. 
Viet supposed them to depend upon a dilatation of the canals 
of Gartner, and probably this theory may be in some cases 
correct. The cyst contains a liquid varying in color and 
properties to a considerable extent. Sometimes it is thin, 
serous, and white ; at other times it is found thick, white, 
and albuminous; again, bloody, reddish, or yellowish brown. 
In pregnant women small cysts of the vagina sometimes 
occur which are filled with gas in part. 

Etiology. 

But little is known of the etiology of vaginal cysts. 
Bruising of the vagina and extravasations of blood have 
been thought to be the cause. If this was so the contents 
of the cyst would more frequently be found to be blood or 
pus. Obstructed follicles from inflammation is all right in 
theory, and may be correct in the majority of cases; but if 
asked, Why should they so generally occur singly? we 
would be at a loss for an answer. I am of the opinion 
that slight serous effusion from circumscribed cellulitis, is a 
more plausible theory of their causation than any I have 
before suggested. 



CYSTS OF THE VAGINA. 415 



Symptoms. 



Small cysts in the vagina present no symptoms. Large 
ones offer obstruction to copulation, and when pendulous 
interfere with walking. I removed one of- this kind last 
year; it protruded as large as a small orange from the vulva. 
It had been treated as a cystocele by a reputable physician 
of this city, unsuccessfully. 

Diagnosis. 

The main trouble in diagnosis is to distinguish a cyst of 
the anterior wall of the vagina from a cystocele. This is 
best accomplished by introducing a flexible catheter into the 
bladder, and drawing off all the urine, while we press the 
tumor well up into the vagina. If it be a cystocele the size 
of the tumor will then be found materially diminished; if a 
cyst of the vagina, not altered in size. The vaginal cyst in 
the posterior wall of the vagina is easily diagnosed from 
rectocele, with which it is possibly confounded, by combined 
rectal and vaginal touch. 

Treatment. 

The treatment of vaginal cysts, when of a size sufficient 
to incommode the patient, consists in drawing off the con- 
tents of the cysts by means of an ordinary trocar; if the 
cyst refills (which it is very likely to do) it must be again 
drawn off, and the sac injected with dilute Comp. Tr. Iodine. 
I dilute the Compound Tr. about one-half, and allow it to 
remain in the sac about ten minutes, and then flow away 
through the canula of the trocar. 

After this is accomplished the sac should be compressed 
so that its sides may adhere and its cavity be obliterated. 
In order to accomplish this object the inflatable rubber bag 
may be inserted into the vagina, and well inflated. In this 
situation it should be allowed to remain several days, though 



416 EATON ON DISEASES OF WOMEN. 

it may be removed, cleansed, and re-introduced every two 
days or such a matter. Should we find, after inserting the 
trocar, that the contents of the sac were too thick to readily 
pass through the canula, Ave may insert a small sized bougie, 
or a probe, and break down the semi-liquid contents of the 
cyst, after which we may use compression to force the con- 
tents of the sac through the canula. 

If by using these means we are unsuccessful in evacuat- 
ing the cyst, we may withdraw the canula, and with a sharp- 
pointed bistoury enlarge freely the puncture already made. 
We now scoop out the cystic contents with the finger or a 
sjooon-shaped probe, and mop the interior of the cyst with 
Tr. Iodine Comp. It is important, I have found (and rea- 
son as well teaches), that the Comp. Tr., instead of the Tr. 
of Iodine, should always be used in the treatment of all 
cases where it is desirable to awaken adhesive inflammation 
in cysts of any variety. The Tr., if diluted with water or 
serum, precipitates the Iodine, and produces rather more in- 
flammation in spots than is desirable, and much less than we 
wish in the balance of the sac. The Comp. Tr. Iodine is 
capable of any amount of dilution with water or serum with- 
out precipitating the Iodine, so that from its use we obtain 
an even effect upon the entire surface which it touches, even 
if it gets somewhat diluted. 

The effect of the deposit of free Iodine in crystal upon 
the interior of any sac or cyst might develop dangerous in- 
flammatory action, and still fail of affecting any ways favor- 
ably the remainder of the cystic wall. What is wanted is 
to excite an irritation in the lining of the sac which will be 
just sufficient, and no more, than to cause adhesive inflam- 
mation; and the effect should be uniform, and not burn a 
piece of membrane in one place and produce no effect upon 
the greater part of the cyst, as often results when the pure 
Tr. is used. 

The same remarks apply with almost equal force when 



FIBROIDS AND POLYPI OF THE VAGINA. 417 

we desire to use Iodine with a swab or brush; hence we un- 
qualifiedly prefer the compound Tr. of Iodine when we use 
Tr. at all, and in most cases a solution made with water in- 
stead of alcohol is preferable, using 3 grs. of Kali hydriodi- 
cum to each gr. of Iodine. Maintaining this proportion, we 
may make a saturated solution, or make one as dilute as im- 
agination itself. 

Fibroids of the Vagina. 

Schroeder* speaks of fibroids of the vagina. I can find 
no other author who has claimed to have seen one. The 
tumor which he saw was of the size of a walnut, and was 
situated in the right side of the vaginal cul de sac. It oc- 
curred in connection with a uterine polypus the size of a 
child's head. He describes the tumor as soft. His descrip- 
tion is not definite enough to make out a positive diagnosis 
that it was a fibroid. 

Polypi of the Vagina. 

Polypi of the vagina are of exceedingly rare occurrence, 
although papillary growths in the vagina frequently occur 
(usually as a syphilitic symptom, however). One case is 
quoted by Dr. Barnes, of London, f reported by Mr. Cur- 
ling, which was attached to the vagina just above the mea- 
tus of the urethra. It projected outside the vulva, and con- 
sisted of dense fibrous tissue. 

Treatment. 

They may be removed by torsion if small, or with the 
ecraseur or ligature and knife if of considerable size, the 
same as fibrous polypi of the uterus. 

Prolapse of the Ovaries. 

Some cases of prolapse of the ovaries are very difficult to 
cure. These displacements often cause severe abdominal 

* Ziemssen's Cyclopaedia, Vol. X, p. 508. t Barnes' Diseases of Women, p. 758. 

27 



418 EATON ON DISEASES OF WOMEN. 

pains. The prolapsed condition of the ovary does not always, 
however, produce severe symptoms, and the more experience 
I have the more I am convinced that the pain is more often 
due to inflammation than displacement of the organs. The 
displacement is caused by increased weight in the ovary 
itself in connection with relaxation of the broad ligament 
upon the affected side, in cases where it is displaced inde- 
pendently of the uterus. This displacement has in former 
years received but little attention, but is worthy of notice, 
in that it explains the difficulties encountered in the cure of 
some obstinate cases, where the disease is obscure, from a 
casual examination. 

The diagnosis is to be made by means of the conjoined 
method, with a finger of one hand in the rectum and two 
fingers of the other hand in the vagina, when the pro- 
lapsed and tender ovary is felt at the side of the poste- 
rior part of the vaginal cul-de-sac. These displacements 
become doubly painful during copulation, owing to the in- 
creased congestion of the parts produced by the excitement 
of the act. 

The ovary is sometimes so extremely displaced as to be 
denominated ovariocele, and in other instances hernia of the 
ovary ; but these conditions are treated of separately under 
these heads, and are not considered under the head of simple 
prolapse of the organs. 

The ovary is displaced downwards in connection with pro- 
lapsus of the uterus, and sometimes remains somewhat pro- 
lapsed after the uterus is reinstated, and causes pain in the 
pelvis and abdomen. Differentially it is very hard sometimes 
to distinguish cases of this kind from a circumscribed cellu- 
litis. In the circumscribed cellulitis in the region of the 
ovaries, the thickening of the tissues is broader in extent from 
side to side than from before backwards, while the ovary feels 
nearly round, though oblong in shape. 



PROLAPSE OF THE OVARIES. 419 

Treatment. 

The treatment of prolapse of the ovary is not always 
easy or satisfactory, on account of not using a sufficient 
amount of reason in the application of means for its relief, or 
on account of adhesions which have formed, and which bind 
it down to its abnormal position. 

The abdominal viscera should be lifted off the pelvic 
organs as a first principle, either by causing the patient to 
maintain the horizontal position with the hips elevated, or by 
means of an abdominal supporter properly adjusted. The 
next step is to elevate the uterus above its normal position, 
so that the ovary may also be elevated. This is well accom- 
plished in many cases by means of the elastic inflatable rub- 
ber bag. This should be used of large size, so as to quite 
completely fill the pelvis. Place the patient in the knee- 
elbow position before pressing up the uterus or inserting the 
rubber pessary, so that there may be no pressure from 
the weight of intestines to interfere with the rise of the 
uterine organs. This crowds the uterus and ovaries up to a 
normal position, better than any other means with which I 
am acquainted. The support should be maintained for several 
weeks, removing, cleansing, and readjusting the pessary as 
often as is necessary for cleanliness. This also compresses 
the cellular tissue, so that it may become more firm, and gives 
the broad ligaments an opportunity to gain strength, so that 
when we remove the support, and the uterus settles to 
its normal position, the ovary may remain where it is and 
should be. 

In these cases we may have some inflammation of the 
ovary to contend with — not, however, resulting from the 
treatment, but from the displacement. To relieve this the 
Bromide of Potassium should be given sufficiently to be- 
numb the passions. The sexual instinct should be, for the 
time, kept in entire subjection and as dormant as possible. 



420 EATON ON DISEASES OF WOMEN. 

Rest and quiet, both to body and mind, should be enjoined. 
Neuralgic dysmenorrhoea is likely to complicate these cases, 
and give an indication for Macrotine, Puis., Cimicif., Aeon., 
Ars., China, or Bell. 

Should cellulitis complicate the case Ave are obliged to 
trust to position and remedies, and we can not use the in- 
flatable bag in the vagina, as the pressure from it could not 
be tolerated,, until the cellulitis had been relieved. 



ABORTION. 421 



CHAPTER XXXVI. 

ABORTION. 

This term is applied to the expulsion of the foetus at 
any period of gestation previous to the seventh month. 

Abortion is a fruitful cause of disease in women, and 
should be understood, that its earliest manifestations may be 
subdued, that the accident may, if possible, be averted. It 
should be understood, that it may be conducted with safety 
to the mother, in case it can not be prevented. It should 
be understood, that we use no treatment or remedies upon a 
patient who is pregnant calculated to cause her to abort; and, 
finally, that we may treat properly the conditions caused by 
the abortion, in case one has occurred. 

We must consider abortion a disease, and the desire 
among women to produce it is an evidence of a diseased 
state of society, which of course is made up of individuals. 
Hence ' the minds of these individuals must be diseased, or 
at least perverted in judgment. Objection to maternity seems 
to largely pervade the minds of American women. This 
sIioavs that a healthy sentiment has not pervaded society for 
years past, and that unless a change occurs in this regard, 
the very foundations of government are endangered. It 
therefore becomes the physician's duty as a philanthropist 
and patriot, as well as a physician, to use all his influence to 
cause women to look upon maternity as a blessing, and that 
in the proper training of children women have an oppor- 
tunity to shape the destinies of nations. Their power in 
this way is equaled by none on earth. Can they not see that 
in this direction there is an opportunity for influence greater 
than they can exert in any sphere as Jadies of fashion in 



422 EA TON ON DISEASES OF WOMEN. 

gay society? Here are in store for them honors as far ex- 
celling those received by the gay butterflies of fashion, as 
the noonday's sun excels in splendor the flicker of a fire-fly. 

The extent to which criminal abortion is carried on in 
this country (and I may add among some of the nations of 
Europe,) is astonishingly large, and its magnitude will only 
be fully realized at the judgment day. 

This practice has destroyed the health of many a robust 
woman, and made her a poor wreck of humanity unfit to 
propagate or rear offspring. 

We can not feel it just to omit to say, in this connection, 
that the men of our time are by no means clear of blame in 
this regard. They have failed to show their wives that they 
appreciate the trials and pains incident to motherhood; have 
failed to show their appreciation of children, of home, of 
the home circle, by absenting themselves too much from the 
companionship of wife and children, and have found too 
much pleasure in the club, the lodge, or the saloon. Nor 
is this all. Too often have they fallen into temptations 
while from home which have resulted in contaminating their 
blood with syphilitic virus, which has caused the wife to feel 
she is doing humanity a service to refuse to be a party to 
the passing down to posterity any of the contaminated blood 
in her husband's veins. 

There are, however, accidental abortions dependent upon 
various causes, the 

Ktiology 

of which we will now consider. They may arise from any 
cause which produces a separation of the attachment of the 
ovum to the interior uterine surface. This is most readily 
accomplished when the attachment is feeble, as I believe 
it is when a small number of spermatozoa penetrate the 
ovum (as I have mentioned in connection with the discus- 
sion of moles). There may reasonably be supposed to be, in 
some instances, a deficiency in strength or vitality in the 



ABORTION. 423 

spermatozoa, as well as a deficiency in their number. The 
inflamed irritable condition of the endometrium, muscular tis- 
sue, or nerves of the uterus may predispose to cause con- 
tractions of the organ, and produce death of the ovum at 
any stage of development after impregnation. Hard work, 
lifting, straining, jumping, etc., excessive sexual intercourse, 
cold, vaginal injections, drastic cathartics, or violent emotions 
of the mind may cause death to the foetus in utero, and con- 
sequent abortion. The nursing of a child at the time gesta- 
tion is going on may, by means of the exhaustion induced, as 
well as from the stimulating effect upon the uterus, from the 
irritation of the breasts through the sympathetic nerves, 
cause abortion. 

Symptoms. 

Uterine hemorrhage or pain, coming on in the pregnant 
woman, are symptoms of threatened abortion, as a rule. (In 
very exceptional instances women menstruate moderately 
Avhile pregnant.) We must not consider a slight show, oc- 
curring at regular monthly periods, as evidence of a threat- 
ened abortion in all cases. This is not to be considered 
a hemorrhage, but menstruation. But where the flow comes 
on irregularly, and is sometimes quite profuse, accompanied 
with occasional uterine pains, we can be sure an abortion is 
threatened, if the woman is pregnant. 

A considerable chill is often a symptom indicating the 
death of the foetus, although the chill is not accompanied with 
uterine hemorrhage or pain. In this case faintness, and in some 
instances convulsions, come on, and still more clearly indicate 
the nature of the impending crisis. By making a physical 
examination we find the os uteri somewhat dilated, varying 
in size according to the stage of gestation and the time 
which the other symptoms of abortion have been going on. 

As abortion progresses the os uteri becomes more dilated. 
and the pains become more regular and severe. Hemorrhage 
is not usually profuse when there are severe uterine contrac- 



424 EATON ON DISEASES OF WOMEN. 

tions. In some cases an immense amount of blood is lost 
per vaginam, faintness comes on, there is coldness of the 
extremities, and the blanched countenance, and still no pains 
in the uterus. These symptoms not only indicate that abor- 
tion is impending, but that death itself is hovering near to 
claim its victim. 

A gush of water from the vagina indicates the rupture 
of the membranes and the escape of the amniotic fluid, and 
shows that abortion is unavoidable, as is also evidenced by 
the preceding train of symptoms. Usually, after the rup- 
ture of the membranes, uterine contractions come on with 
increased frequency and severity, and the hemorrhage is 
much decreased, or entirely stopped. The danger to the 
mother is now much less, but the savins: of the foetus is out 
of the question. There occasionally occurs a case which 
might be at first considered as exceptional to this rule. 
I refer to cases where the rupture of a single cystic polypus 
of the uterus simulates the rupture of the membranes. I 
have, however, never seen a case of this kind occur previous 
to the seventh month of gestation. After the seventh month 
I have seen several where there were severe uterine contrac- 
tions, and the rupture of a single cyst, either connected with 
the uterus or ovum, which seemed to threaten premature 
delivery, but was averted by proper remedies and means; 
and the women went on to full term, and were delivered of 
healthy children. I do not remember that either case was 
complicated Avith uterine hemorrhage. These cases were 
threatened premature delivery, and not threatened abortion, 
as they occurred subsequent to the seventh month. 

Puerperal convulsions are not very common in cases of 
threatened abortion ; still, they do sometimes occur. I rec- 
ollect a case where the patient was thrown into violent 
puerperal convulsions after taking Oil of Tansy to produce 
an abortion upon herself. I have also seen them produced 
by the death of the foetus from accidental causes. 



ABORTION. 425 



Diagnosis. 



The diagnosis of a miscarriage is ordinarily easy from 
the symptoms which I have given; but there are sometimes 
cases which are very perplexing. These women have, per- 
haps, been regular in their menstrual flow, though it has 
been scant in amount for one, two, or three months before. 
In these cases we have to rely upon the accompanying 
symptoms to enable us to decide whether our patient is 
really pregnant and is threatened with abortion, or whether 
it is a case of dysmenorrhea with amenorrhoea. The size 
of the uterus aids us in some cases; in others, the uterus is 
abnormally large from congestion or sub-involution, and it is 
next to impossible to be positive in the diagnosis. In such 
a case we should give the patient the benefit of the doubt, 
stop the pains, and let time clear up the diagnosis. 

Again, in women who have reached the climacteric 
period, and have missed their catamenial flow for a period of 
two or three months, and then are attacked with uterine 
hemorrhage and pains, the diagnosis is difficult. Usually 
these cases prove not to be pregnant, but I have seen a foetus 
expelled from such a patient even at .the age of fifty-three 
years. So we do well to be on our guard even with these 
old patients. 

Uterine polypi may cause hemorrhage and uterine con- 
tractions, and have, of course, an enlarged uterus to contain 
them, and greatly simulate the case of threatened abortion. 
The history of these cases will usually throw light upon the 
diagnosis. Generally, in the history of a case of uterine 
polypi there has been no period of cessation of menstruation, 
the flow having been profuse instead of scanty. This is not, 
however, proof positive, as in some instances of uterine 
polypi the menstruation is for a time nearly or quite arrested. 
In such a case we must also give time a chance to clear up 
the diagnosis. 



426 EATON ON DISEASES OF WOMEN. 

In the attempted expulsion of the uterine polypus, as 
well as the threatened abortion, the os uteri is found some- 
what open. If dilated so as to admit the finger, and we can 
feel the fluctuation of the water within the membranes, of 
course we know, usually, that there is pregnancy and a 
threatened abortion in the case. The polypus might, how- 
ever, be soft, and deceive us ; but this would occur seldom, if 
ever, for the history of the case must always be taken in 
connection with the physical evidences we find. 

Prognosis. 

We can usually prognose, that if the patient is like other 
women she is likely to have trouble following, although years 
of breath in the body may be allowed her, for want of care 
of themselves is characteristic of women who produce this 
state of affairs or upon whom it is brought accidentally. 
The physician should warn his patient of the danger of care- 
lessness after abortion, and induce her, if possible, to exercise 
the greatest degree of caution against taking cold or taking un- 
due exercise. Death may result directly from loss of blood, or 
from convulsions, or from inflammation following the abortion. 
Sterility may result, and a, long train of female diseases may 
be anticipated in very many cases, among the most prominent 
of which I may mention sub-involution of the uterus, chronic 
metritis or cervicitis, displacements of the uterus , uterine tumors, 
and the long array of sympathetic symptoms, whose name is 
legion. One abortion always predisposes to another, should 
pregnancy follow the first. 

Treatment. 

The first thing to consider in the treatment of a case of 
threatened abortion is, whether it is possible to prevent it. 
In order to decide this question, it is necessary to take into 
consideration the strength of the patient, the amount of 
hemorrhage and pain which she has suffered, and the length 



ABORTION. 427 

of time which has elapsed since threatening symptoms have 
been manifested. Some considerable uterine pain, with a mod- 
erate amount of hemorrhage, may not make the loss of the 
conception positive, and active means must be used to arrest 
the pain and the flow, or at least we should be active in the 
use of means. The first thing is to insist upon perfect rest, 
in the horizontal position, and at once administer Secale cor. 
6 X dilution at hourly or half hourly intervals. Cool, wet 
cloths should be applied over the epigastrium in cases of 
severe hemorrhage, but where there is uterine pain without 
severe hemorrhage the warm cloths are most desirable and 
useful. Aconite, Bell., or Ipecac are indicated for the hemor- 
rhage, with heat of skin or nausea. Arnica is useful if the 
pains are the result of lifting, straining, a fall, or any trau- 
matic injury, including excessive venery. 

After the pains have ceased and the hemorrhage is 
arrested, we must still enjoin perfect rest for several days; 
and no violent exercise should be taken during the entire 
course of gestation, for after one attack' of pain or hemor- 
rhage, from whatever cause, the patient is more liable there- 
after to another attack. Cool drinks should be given and 
the air of the bed-chamber should be as pure and fresh as 
possible, with a careful regard to proper temperature, which 
should always be maintained at a rather low standard. 

If the case presents alarming symptoms when it comes 
under our care, if convulsions are present, having been pre- 
ceded by a chill or otherwise, if the uterine hemorrhage 
is profuse and has been so for several hours, if the uterine 
contractions have been frequent and severe for a long time, 
or if the membranes have ruptured, we can not hope to save 
the foetus, and we must try to save the mother. To do this 
the sooner the uterus is emptied the better. But we can not 
always accomplish thi.s at will. We may give Secale cor. in 
mother Tr. i 3, doses in warm water, every twenty minutes. 
We may irritate the interior of the cervix by sweeping the 



428 EATON ON DISEASES OF WOMEN. 

% 

finger around in it, by which means we also dilate it; still 
hemorrhage may go on, and no uterine contractions be in- 
duced to control it. It now may become necessary, in such 
a case, to tampon the vagina. This may be conveniently 
done with the elastic rubber bag, with tube and stop-cock. 
If the bag is not at hand, a silk handkerchief may be pressed 
up into the vagina, and distended with raw cotton or 
pieces of cloth. This will arrest the hemorrhage, if the tam- 
pon fills the vagina perfectly, causing a clot to form in the 
cervix, and this holds the blood in check, as the uterus will 
not dilate to any considerable extent in case the foetus is still 
within the uterus. (After confinement at term or premature 
delivery, and even in cases after an. abortion of a six months' 
gestation, this would be an unwise and unsafe mode of arrest- 
ing hemorrhage.) 

After a time, varying in different cases, uterine pains 
usually come on actively, especially if stimulants are given, 
or we wait a sufficient time for the forces of the system to 
recuperate. We now remove the tampon in the vagina and 
aid the expulsion of the foetus and placenta as much as possi- 
ble, pursuing the same rules of practice which should guide us 
in assisting a delivery at full term. (This does not include 
going to sleep and letting the patient take care of herself, 
as is the custom of some of those who have at their tongues' 
end and are always repeating the old adage, that " meddle- 
some midwifery is bad.") 

After the delivery of the foetus, the utmost skill and 
promptitude should characterize our efforts to secure the 
prompt and entire delivery of the secundines. A failure to 
attend to this properly is likely to be followed by severe 
hemorrhage, if not septicaemia. Herein lies largely the im- 
mediate danger from abortions. To obviate this we should 
see to it that uterine contractions are induced, and if they are 
not sufficient to detach the secundines, a well curved uterine 
sound should be introduced (in case we can not introduce a 



ABORTION. 429 

finger up to the attachment), and by gently sweeping it around 
the interior of the uterine surface, we may detect the point of 
the placental attachment, when we should endeavor to sepa- 
rate it by gentle but steady pressure sidewise with the sound. 
After it is detached its expulsion is readily secured, either 
by uterine contractions, or by means of the fingers, or a 
slender pair of uterine placental forceps. Rest, bland nour- 
ishment, and quiet are now demanded, and we should give 
such homoeopathic remedies as the symptoms indicate. 

When called to a case where the placenta has been long 
retained the same principles govern. (I have removed one 
which had been retained for about eight weeks, the hemor- 
rhage from which had nearly killed the lady.) In such 
cases, of course, China, Ars., Nux, Rhus., etc., are the indi- 
cated remedies, with nourishing diet, rest, and fresh, pure air. 
In case metritis, peritonitis, leucorrhoea, or any other diseased 
condition, remains as a sequence of abortion, these conditions 
demand treatment peculiar to them, and are treated of in 
this work under their appropriate heads. 

Henry Minton,* A. M., M. D., of Brooklyn, says of the 
treatment of abortion: 

"In dealing with threatened or actual abortion, from 
whatever cause it may arise, the patient must be enjoined 
at once to the recumbent position, in a cool room, free from 
all noise and excitement; and before any line of treatment 
is adopted we should make a thorough examination of the 
uterus and all the discharges. If we find the uterus empty, 
or the foetus and secundines among the discharges, we should 
treat the case as one of ordinary labor at term. If, on the 
other hand, we find that no portion of the ovum has been 
expelled, though the os be slightly open, hemorrhage free, 
and the pains severe, at once make a vigorous effort to avert 
the threatened accident. Enforce absolute rest ; this is nec- 
essary to the success of the remedies you will then prescribe. 

*Hom. Jour. Obs., Feb., 1880. 



430 EATON ON DISEASES OF WOMEN. 

" The physician unacquainted with the effect of potentized 
remedies in cases of this kind will be both astonished and 
gratified at the happy results following their administration. 

"When prescribing give preference to that remedy which 
best covers the nature of the discharge, the peculiarity of 
the pains, the general habits of the body, and mental condi- 
tion of the patient. 

Remedies for a Predisposition to Abortion. 

"Act. rac, Aletr., Apis, Asarum., Aur., Bapt., Calc. c, Caul., 
Ferr., Helon., Hyos., Kali c, Lye, Puis., Sabina, Sepia, Silic, 
Sulph., Viburnum. 

Threatened Abortion. 

"Aeon., Act. rac, Ambra, Apis, Arnica, Asarum, Bapt., Bell., 
Bry., Calc. c, Cannab., Camph., Caust., Caul., Cham., Chin., 
Cinnam., Coff., Crocus, Erig., Ferr., Gels., Helon., Hyos., Ipec, 
Kali c, Nux m., Nux v., Opi., Pod., Puis., Rhus t., Sabina, 
JSany.y Secale, Sepia, Silic, Stram., Sulph., Thuj.^ Trill., Verat. a., 
Viburnum. 

Time of its Occurrence. 

Second month : Apis, Kali c. 

Third month : Crocus, Sabina, Secale, Thuj. 

Fifth month to the seventh : Sepia. 

In the early part of pregnancy: Apis. 

In the last months of pregnancy: Opi. 

Causes. 

Anaemia: Alet., Calc. c, China, Ferr., Secale. 

Congestion of the uterus : Act. rac, Bell., Canth., Caul., China, 

passive : Caul., Secal., list. 

with ulceration : Canth. 

Constipation: Apis, Bry., Nux v., Silic. 
Cystitis : Aeon., Cannab., Canth. 
Disposed to hemorrhages : Calc. c, Ham. 



ABORTION. 431 

Epidemic influenza, during : Camph. 

Exposure to cold or dampness, from : Dulc, Puis. 

Fright: Aeon., Gels., Opi. 

when the fear remains, she can not get over it: Aeon. 

Gonorrhoea : Cannab. 

Induration of cervix : Aur., Con., Sepia. 

Inertia, uterine : Caul., Cimicif., China. Ferr., Puis., Sabina, 

Secale, list. 
Leucorrhcea: Calc. e., Camph., Lye., Sepia, Sulph. 
Nervous sensibility, excessive : Asarum., Ferr. 
Plethora: Aeon., Apis, Alet., Calc. c, Sabina. 
Shocks, fills, bruises, or concussions : Arnica. 
especially if she commences to 

floAv, with or without pain; or pain, with or without 

flow : Arnica. 
Spinal affections : Silic. 
Strain of the loins, or over-exertion : Rhus. t. 

Causes. 

Strain in the loins, from a false step, or over-reaching: China. 

Sudden depressing emotions : Gels. 

Suppressed grief: Ignat. 

Syphilsemia: Aur., Merc, Nit. ac, Phytolac, Staph., Thuj* 

Typhoid fever: Bap. 

Character of the Discharge. 

Black : Asar., Crocus, Kreos., Plat., Puis., Secale. 

and coagulated : Cham., Chin., Ferr., Crocus, Puis., 

Sabina. 
in gushes : Puis. 



mixed with foul-smelling coagula : Secale. 
stringy: Crocus. 
thick: Plat. 



liquid: Secale. 



432 EATON ON DISEASES OF WOMEN. 

Black and offensive : Cham., Crocus, Kreos., Secale. 

Bright red : Arnic, Bell, Cinna., Erig., Hyos., Ipec, Rhus t., 

Sabina, Trill., list. 

aggravated by motion : Sabina, Trill, Ust. 

continuous : Hyos., Ipec 

feels hot as it passes : Bell. 

in gushes : Sabina, Ust. 

■ intermittent : Bell., Rhus t., Sabina, Ust. 

Bright red, not coagulating : Ham. 

or dark, with coagula : Sabina. 

— readily coagulating : Ipec. 

with coagula: Arnic., Bell., Ipec., Sabina, Ust. 

Coagulated : Arnic, Bell., Cham., Chin., Crocus, Ferr., Helon., 

Ipec, Plat., Puis., Sabina, Secale, Ust. 
Comes suddenly, and ceases as suddenly as it came : Belt 
Continuous : Arnic, Cinna., Ham., Hyos., Ipec, Sabina, Ust. 

but not profuse : Ust. 

with nausea : Ipecac. 

Dark: Bell., Bry., Cham., Chin., Crocus, Ferr., Helon., Kreos., 

Nux m., Plat., Puis., Sabina, Secale, Trill., Ust. 

and aggravated by motion : Crocus. 

- — — mixed with congula : Bell., Cham., Chin., Crocus, 

Ferr., Puis., Sabina, Secale, Ust. 

dark : Sabina. 

foul : Secale. 



fluid : Bry., Plat., Secale. 

offensive : Cham., Crocus, Kreos., Sabina, Secale. 

thick : Nux m., Plat. 

Fetid : Bell., Cham., Crocus, Kreos., Sabina, Secale, Ust. 

Gushes in: Cham., Chin., Puis., Sabina, Secale, Ust. 

Hot, feels hot as it passes the vulva: Bell. 

Intermittent : Chin., Kreos., Puis. 

Offensive : See Fetid. 

Partly thin or watery, and partly black and coagulated : Ferr. 



AB0RT10X. 433 

Passive : AM., Caul., Chin., Crocus, Ham., Helon., Secede, Ust. 
Profuse : Apis, Arnica, Bell., Cham., Chin., Cinna., Crocus, 

Frig., Ferr,, Helon., Ipec, Hyos. Sabina, Secale, Trill. 
Scanty : Caul., Nux v. 
Sudden : Bell., Cinna. 

Suddenly ceases and as suddenly returns : Bell. 
Watery: Chin., F err., Kreos., Sabina, Secale. 

and mixed with coagula: Chin., Ferr., Sabina, Secale. 

Worse from motion : Coff., Crocus, Erig., Sabina, Secale. 

Character of the Pains — Hypogastric and Uterine Region. 

Pain about the umbilicus, passing off into uterus : Ipec. 

alternating with hemorrhage : Cham., Puis., Secale. 

and distention : Chin., Lye. 

faint sick feeling in the abdomen : Seibina. 

heaviness in : Cham. 

motion in from something alive : Crocus. 

excites a desire to defecate : Nux v. 

great restlessness and agony : Cham. 

in burning: Bry. 

colicky : Bell., Calc. c. Chin., Sepia. 

cutting, with frequent desire to urinate : 

Cham. 

crampy uterine : Cocc, Nux m., Vib. 

with cutting stitches : Ignat. 

labor-like : Apis, Bell., Calc. c, Caul., Cham., 

Hyos., Ipec, Kali, c. Nit. ac. Nux v., Nux m., Opi., 

Plat., Puis., Sabina, Secale, Sepia., Ust. 
alternating with hemorrhage : Cham., 

Puis., Secale. 
as if the pelvic contents would issue 

through the vulva : Bell., Nit. ac, Sepia. 
beginning in the back and extending 

into the thighs : Kali c. 
« ovarian region : Podo. 



2S 



434 EA TON ON DISEASES OF WOMEN. 

coming suddenly and as suddenly 

vanishing: Bell. 

— extending to the sides : Cham. 

thighs : Apis, Cham., 

Kali a,, Sang., Vib. 

periodical : Cham. 

shooting from right to left across the 

spasmodic : Caul. 

the result of injury : Arnica. 

with frequent desire to urinate : Cham. 

pressure on the uterus and rectum ; Ipec. 



abdomen : Lye. 



shooting to the legs : Vib. 

stinging in ovarian regions : Apis. 

Sinking, empty feeling in: Lgnat., Sepia. 
Tremulous sensation in : Plat. 
Weakness in: Phos. 
Weight in : AM. 

Back. 

Pains from, directly through the pubis : Sabina. 

in aggravated by motion : Bry. 

as if it would break : Bell., Kali c. 

drawing : Rhus. 

beginning in the back and extending into the 



thighs : Kali c. 

- intolerable before passing water : Lye. 

— , ■ paralytic, rendering the -legs almost useless : Cocc. 

severe in back and loins : Caul. 

small of: Asar., Bell., Cole., Lye. 

attended with great weakness : Kali c. 

Spinal affections : Silic. 

Mental Condition. 

Anxiety, great: Aeon., Arnica Bell., Kali c., Seeale. ^ 

- and palpitation of the heart : Cole. 



ABORTION. 435 



sadness : Secede. 
timorousness : Bell. 



with great fear : Kali c. 

nervous excitability : Aeon. 

Can not bear to be talked to : Hyos. 

Confusion of mind : Bry. 

Cries and trembles, does not know what to do : Coff. 

Delirium: Hyos. 

after severe flooding : Chin. 

Depression of spirits : Ferr., Ignat., Lye., Sepia, Ust. 
Desire to talk about her condition : Nux v. 
Dread of men : Puis. 
Dull and stupid : Opi. 

gloomy : Helon. 

Ecstatic mood : Stram. 

Fear of death : Aeon., Apis, Coff., Gels., Kali c., Seeale, Stram. 

is sure she will die from the hemorrhage : 

Aeon. 

is sure she will abort : Nux m. 

Full of desires : Ipec. 

tears : Pals. 

Hysterical: Ferr., Hyos., Nux in., PJios., Sabina. 

alternation of laughing and weeping : Hyos., Phos. 

Illusions, every thing around her seems small, and every body 

seems inferior to her : Plat. 
Imperious manner: Lye. 
Irritable : Cham., Ipec., Nux v., Sepia. 
Lascivious mania : Hyos. 

Laughter, every thing seems ludicrous : Nux m. 
Loquacious : Hyos., Stram. 

indistinct muttering : Hyos. 

Makes irrelevant answers : Hyos. 
Mild, gentle, tearful, yielding: Puis. 
Moans, which affords relief: Bell. 
Momentary arrest of thoughts : Asar. 



436 EA TON ON DISEASES OF WOMEN. 

Mood, suicidal : Aur. 

Morose and serious : Bell. 

Nervous : Asar., Cham., Chin., Ferr., Opi. 

and hysterical feeling : Ferr. 

irritable : Cham., Nux v., Opi. 

Obstinate and passionate : Bry. 
Over-sensitiveness : Bell., Nux v. 
Quietly disposed : Trill. 
Restless : Aeon., Bapt., Dulc, Rhus t. 

anxiousness : Crocus. 

quarrelsome : Dulc. 

mental : Bapt. 

Short time seems a long while to her : Nux m. 

Sighing and sobbing : Ignat. 

Startled easily : Bell., Cocc. 

Stupid, half-asleep condition : Opi., Secale. 

Taciturn : Nit. ac. 

Tearful : Puis. 

Thinks herself well : Kreos. 

she is not at home : Opi. 

Weeps much : Kali c" 



CYSTS OF THE BROAD LIGAMENT, 43' 



CHAPTER XXXVII. 

CYSTS OF THE BROAD LIGAMENT, AND DISEASES OF THE FAL- 
LOPIAN TUBES. 

The cysts which sometimes develop in the folds of the 
broad ligament should be well understood, that if possible 
they may be correctly diagnosed, as they are somewhat likely 
to be thought to be ovarian tumors. This error of diagnosis 
leads to an error in treatment, and the patient's life is en- 
dangered by an operation for their removal, which is quite 
unnecessary. 

Etiology and Pathology. 

The etiology of cysts of the broad ligament we are 
unable to satisfactorily explain. They probably arise from 
irritation between its folds. They sometimes exist of very 
small size, and are only discovered at the post mortem. In 
other instances they attain to an enormous size. They 
contain a watery, slightly albuminous fluid. The sac is thin, 
although sometimes thickened in a part of its surface from 
deposit of fibrinous material. They seldom attain to the 
immense proportions of some of the larger ovarian cystoma. 
The small-sized cysts are supposed to be from the terminal 
bulb of the tube. Cyst of the broad ligament is usually 
pedunculated. 

Diagnosis. 

They develop in the iliac regions like ovarian tumors, 
but are more fluctuating while yet small. (The ovarian 
tumor is usually hard while small.) As they become larger 
they may be felt fluctuating equally on all sides and in every 
direction. When only of the size of an egg they may some- 
times be felt in Douglas' pouch, soft and fluctuating. The 



438 EATON ON DISEASES OF WOMEN. 

symptoms complained of are weight in the pelvis, together with 
tenderness, some nausea, prostration of strength, etc. ; but 
there is little disturbance of the menstrual function for some 
time, and in some cases not at all. When there is any 
trouble in this direction it manifests itself by a more than 
ordinarily free flow. (See page 301 for differential diagnosis.) 

Prognosis. 

The prognosis is favorable in the majority of cases of 
cysts of the broad ligament. The cyst may rupture sponta- 
neously and recovery take place without any very serious 
symptoms, the contained fluid not usually producing any irrita- 
tion of the peritonaeum in case the cyst is not large. They 
may be removed by tapping with but little danger to life, and 
they are not liable to refill. When mistaken for ovarian cys- 
toma, and an operation for their removal is attempted, the 
dangers of the operation are greater than those to be appre- 
hended from allowing the cyst to remain. Still, after the 
abdomen is opened, the sac and contents better be removed. 

Treatment. 

The small cyst in Douglas' pouch may be evacuated with a 
long trocar, with little risk, through the posterior vaginal Avail; 
but when they cause little or no inconvenience they should 
be let alone. When of large size, so as to be cumbersome in 
the abdomen, they should be evacuated with a canula or aspi- 
rated through the abdominal walls. It has been recommended 
to inject them with Iodine at once ; but this is not necessary. 
They usually do not refill after they are drawn off thor- 
oughly. Should they do so, we may inject them after the 
second aspiration with greater propriety, using a solution of 
Iodine of about the strength of fifteen grs. of Iodine to the 00., 
which should be aspirated out of the sac after it has been 
introduced ten minutes or so. There is always some danger 
in these cases that the Iodine will escape into the peritonseal 



DISEASES OE THE FALLOPIAN TUBES. 439 

cavity, and produce peritonitis. Hence we should not use 
the injection unless we find the sac refills. 

When aspirating a cyst of the broad ligament, the abdom- 
inal many-tailed bandage should be applied and tightened by 
assistants, that the patient may not suffer from the shock of 
having so much pressure suddenly taken off the abdominal 
muscles, as is caused by the evacuation of a large cyst of the 
broad ligament. In case the abdomen is opened for the removal 
of a fibro-cyst of the ovary, and the case is found to be a cyst 
of the broad ligament, we may proceed to evacuate the cyst 
with the Spencer Wells' trocar, ligate the pedicle of the cyst, 
and remove the sac, dressing the incision, the same as after 
ovariotomy. 

Diseases of the Fallopian Tubes. 

TUBAL DROPSY — TUMORS OF THE FALLOPIAN TUBE — HYDROPS TUB.E — FIBROIDS OF 

TUBES MYOMA — CATARRH BLOODY TUMOR — INFLAMMATION— SALPINGITIS — 

PYOSALPINX — OCCLUSION — HYDROSALPINX TUBAL PREGNANCY — CANCER OF 

THE TUBES — DISPLACEMENT OF THE TUBES — TUBERCULOSIS OF THE TUBES, ETC. 

Description and Etiology. 

The Fallopian tubes are liable to various diseases which 
simulate somewhat disease in other organs, especially the 
ovaries, and are present in many obscure cases where the 
diagnosis is difficult. 

Probably the most frequent of these diseases is catarrh 
of the tubes. The diseases of the tubes have the peculiar- 
ity of occurring in both at the same time, as a rule. These 
diseases result most frequently from inflammation, and as a 
rule are a result of the extension of inflammation already 
established in the uterus or peritonaeum. 

The acute inflammatory condition is termed Catarrh of 
the tubes or salpingitis. When chronic, it is termed inflam- 
mation of the tubes. When the canal in the tubes becomes 
partially or wholly obliterated, it is called occlusion. When 
they are occluded at both ends and are open in their central 



440 EATON ON DISEASES OF WOMEN. 

portion, and there is an effusion of fluid into this open space, 
it is termed •' Dropsy of the tube ;" Hydrops lubm or Hydro- 
salpinx, when the fluid is watery; and a bloody tumor when 
it consists of blood. Tubal pregnancy signifies the impregna- 
tion and lodgment of an ovum in the tube. It usually goes 
on till about the third month, when rupture of the tube is 
produced from the distension, and the patient dies of inter- 
nal hemorrhage. Fibrous tumors or Myoma are rare in this 
locality, though they have been found. Simpson describes 
one as large as a child's head. They are usually of smaller 
size, however, and are not frequently discovered till after 
death. When of considerable size and are discovered dur- 
ing life, they are usually supposed to be ovarian tumors. 
If they exist for years and remain about stationary in size, 
the probabilities are that they are fibrous tumors of the 
tube, or uterus; and it is sometimes impossible to tell which. 
We are not justified in advising or attempting the removal 
of either form of these moderate-sized tumors; hence we 
sometimes have to be content without knowing their exact 
attachment, which is immaterial so far as the management 
of the case is concerned. 

Pyosalpinx is the term applied to suppuration of the in^ 
ternal surface of the tube. This may lead to ulceration and 
perforation into the abdominal cavity. 

Forster, Wagner, Van Dessauer and Wylie have re- 
ported cases. Perforations have also been known to take 
place into the rectum and bladder. 

Pyosalpinx must be preceded by inflammation, and it is 
liable to result in occlusion of the tubes, and at least cause 
barrenness. Cancer does not occur primarily in the tubes, 
but may implicate them by its extension from the uterus. 

Symptoms and Diagnosis. 

The symptoms of diseases of the Fallopian tubes are usu- 
ally obscure, and they are sometimes diagnosed by exclusion, 



DISEASES OF THE FALLOPIAN TUBES. 441 

i. e., by evidence which shows the disease is not anywhere 
else. 

First, we have sterility. This may be caused by various 
conditions, but when we find that the vagina and uterus are 
normal in development, location and secretions, and when we 
observe evidences of healthy ovulation, we must conclude 
that in the married woman (who desires offspring, and who 
has a healthy husband) there must be disease or absence 
of the Fallopian tubes. 

When inflammation has pervaded the pelvic organs, and 
we find all evidence of its presence has passed away from 
the uterus, cellular tissue, ovaries, etc., and there is still 
some tenderness upon pressure in the lateral portions of the 
vaginal cul-de-sac, we may strongly suspect salpingitis or in- 
flammation of the tubes. 

Where ovulation appears to go on normally, and still 
there is no impregnation, and no evidence of other disease 
is present, we may suspect occlusion of the tubes. 

If there has been no evidence of disease of the parts, in 
the history of the case, we may suspect congenital occlusion 
of the tubes. 

Tubal pregnancy is to be suspected when we have the 
ordinary symptoms of pregnancy, including a partial arrest 
of the catamenia, with pain in the region of the tubes and 
no enlargement of the uterus, and especially if at about the 
third month symptoms of collapse come on, and the patient 
dies suddenly. 

Fibroma or myoma of the tube may be suspected when 
we can discover a solid tumor in the iliac regions of both 
sides, and we find that the development only reaches a 
moderate size. 

In dropsy of the tube we may sometimes feel the en- 
larged tube by digital examination per rectum, or if of large 
size in the iliac regions. The enlarged tubes in these cases 
feel nodulated or bulbous, like a string of beads the size of 



442 EATON ON DISEASES OF WOMEN. 

hickory-nuts. We have barrenness, of course, with all these 
varieties of diseases of the tubes, if affecting both, which is 
most usual. 

Sometimes the post-mortem reveals the first real knowl- 
edge we have of disease of the tubes. 

Prognosis. 

The prognosis of tubal disease is quite positive in its 
development of barrenness, except in tubal pregnancy, where 
no further conception is likely to follow, as death is the rule. 
Occlusion is, of course, incurable. All the diseases of the 
tubes are little amenable to treatment; and the recuperative 
powers of nature are well shown in recoveries from salpingitis, 
hydrosalpinx, and pyosalpinx, recovery from pyosalpinx being, 
however exceedingly rare. Cases may recover, and we never 
know what the real disease was ; hence, it would be very diffi- 
cult to prove, or show by argument that pyosalpinx had existed 
and recovery had taken place. Dropsy of the tubes is not so 
likely to end fatally. It may end in resolution or absorption, 
or remain for years without causing death. When the dis- 
tension is so great as to cause rupture of the tube death re- 
sults, as in rupture of the tube from tubal pregnancy. 

Treatment. 

In dropsy of the tube, when the distension is so great 
as to produce much annoyance to the patient, it should be 
nspirated through the vaginal cul-de-sac. If of small size 
it may be allowed to remain; and remedies should be 
given according to the indications. Usually Ars. alb., Dig., 
Secale, Apocyn.can., or Spigelia will be found indicated. 

The bloody tumor of the tube may be aspirated, and then 
injected with a weak Solution of Iodine. 

In tubal pregnancy, we recommend that in cases where 
the diagnosis is clear the best treatment is to operate as in 
ovarian tumor, and remove the ovum, together with the tube. 



DISEASES OF THE FALLOPIAN TUBES. 443 

This, in our opinion, offers the patient a chance for life, 
which she has not, if allowed to go on to spontaneous rupture 
of the tube. The trouble arises in making a diagnosis of 
the case. When this can be made positively I am quite 
clear in the conviction that an operation for its removal 
is desirable. I have never attempted the operation, nor do 
I know that it has ever heretofore been recommended, but 
I am disposed to try it on the next case of tubal pregnancy 
which comes under my care. 

If the physician is at hand soon after rupture of the 
tube has taken place, my opinion is, that it is his duty to 
open the abdomen at once, pass a ligature about the tube, 
and remove the part of the tube containing the foetus, 
Sponge out the abdominal cavity and remove the blood which 
is found there as gently as possible. Close the incision care- 
fully and perfectly with interrupted suture and adhesive 
plaster. Stimulate the patient as actively as possible with 
egg-nog, brandy r , beef tea, etc. In this way a life may some- 
times be saved. 

Fibrous tumors of the tubes do not usually require re- 
moval; and when they do the operation is the same as in 
the removal of ovarian tumors, to which the student is 
referred. 

Cancer of the tubes, occurring, as it does, in connection 
with cancer of adjacent parts, requires no special mention 
here. No treatment is likely to avail any thing when the 
disease becomes so extensive as to implicate the Fallopian 
tubes. 

Displacements of the Tubes. — The Fallopian tubes may 
become displaced from various causes, the chief being from 
traction made upon them in cases of displacement of the 
uterus, and in cases of tumors of the ovaries or uterus. 
These displacements are of little account, except as they 
tend to produce barrenness; and in other cases when they 
have become adherent in the pelvis they offer an obstruction 



444 EA TON ON DISEASES OF WOMEN. 

to the rise of the uterus into the abdomen in pregnancy. 
Tumors of the tube itself may also cause displacement. 

Tuberculosis of the Tubes. — Tuberculosis of the tube 
sometimes occurs before puberty, and might prove a cause 
of amenorrhoea; and it may develop at any period of life. 
I know of no way to make a diagnosis before death. It is 
most common that tuberculosis in the tubes is accompanied 
with the disease in some other part or organ, and does not 
often exist as a primary affection in the tubes. 



DISEASES OF THE URETHRA. 445 



CHAPTER XXXVIII. 

DISEASES OF THE URETHRA. 

URETHRITIS, CARUNCLES OF THE URETHRA, IRRITABLE URETHRAL CA- 
RUNCUL^E, ULCERATION, FISSURES OF THE NECK OF THE BLADDER, 
OR MEATUS URINARIUS INTERNES, LACERATIONS OF THE URETHRA 
FROM DILATATION, PROLAPSE OF THE URETHRA, URETHRAL POLYPI, 
ETC. 

Diseases of the urethra are not very well understood by 
most practitioners, and even specialists are sometimes charged 
with overlooking them. These diseases are usually termed 
bladder or kidney troubles by the busy practitioner, and the 
people labor under the same error very often. It is time the 
profession took note of the fact, that diseases of the urethra 
are as important as any. Painful micturition is a matter of 
great moment to a patient who suffers in this way for years. 
(I removed a urethral polypus from a lady two years since, 
and effected a perfect cure, who had suffered untold tortures 
from its presence for over twenty years, her physicians having 
failed to make a correct din gnosis.) 

Etiology. 

Cold and the irritating qualities of unhealthy urine de- 
velop most, if not all, the diseases of the urethra, except 
laceration. Inflammation of the part, called urethritis, is 
the first development, and from the enlargement of the mu- 
oous follicles arise the urethral polypi, and the irritable urethral 
carunculw. Foreign bodies passed into the urethra by intent 
or accident may cause inflammation, and lead to ulceration. 

Diagnosis. 

Chronic cases of painful micturition should be subjected 
to ocular examination. In irritable urethral caruncidw, digital 



446 



EATON ON DISEASES OF WOMEN. 




Fig. No. 44.— Skene's Urethral Endescope. 



examination reveals the presence of enlargements around the 
meatus. The irritable carunculse are extremely sensitive to 
the touch. Occasionally urethral polypi may be felt hanging 

from the urethra ; 
they are not usu- 
ally sensitive to the 
touch, but produce 
straining after mic- 
turition, and fre- 
quent desire to 
urinate, if they are 
attached within the 
urinal canal. By 
ocular examination we discover their attachment and nature. 
They are usually bright pink in color, and vary in size from 
one-eighth of an inch to an inch in diameter. These tumors 
may be found single or multiple. 

If we find no external tumors in or around the urethra, 
we should inspect the interior of the canal as thoroughly as 
possible. An ordinary urethral speculum, with two small 
blades is usually sufficient for this purpose. (See Fig. 45.) 
Dr. Skene, of Brooklyn, has invented a cylindrical speculum, 
through which the urethral canal may very well be examined 
by the aid of a movable mir- 
ror in its interior. Dr. A. 
R. Jackson has also a cyl- 
indrical urethral speculum, 
tapering at one end. 

Whichever instrument 
we use, we must try to be 
sure to find any urethral 
polypus which may be in 
the canal. The chief objection to the use of the cylindrical 
speculum is, that the polypus is likely to be pushed up into 
the bladder, or at least pressed upwards in the urethra, by 




Fig. No. 45.— Urethral Speculum. 



DISEASES OF THE URETHRA. 447 

introducing the speculum. These polypi, being soft and com- 
pressible, are not detected while in the urethra, without con- 
siderable care and skill. For the discovery of a polypus of the 
urethra in the female, I prefer the bivalve speculum, consisting 
of two slender blades. We may distend the urethra, first from 
side to side, and examine the upper and lower sides of the 
canal, and then turn it one-quarter way around, and examine 
the lateral walls. A probe should always be at hand, that we 
may lift up any apparently loose tissue discovered, and ascer- 
tain if it be a polypus. By means of this examination we 
may also discover inflammation, laceration, or ulceration of 
the urethra if they exist. 

Fissure of the neck of the bladder, or internal meatus, 
can best be discovered by making a visico- vaginal fistula, 
and drawing the meatus into view through the fistula by 
means of a tenaculum or with forceps. Lacerations from at- 
tempted dilatation of the urethra affect the mucous and sub- 
mucous tissues, and cause active and sometimes alarming 
hemorrhage. 

Fissure of the internal meatus may sometimes be diag- 
nosed by passing a probe which is somewhat curved near 
the end, which is introduced into the bladder, and then 
withdrawn till the curve at the end presses the neck; 
then gently move it from place to place, and press gently 
downwards. If we find no pain is produced, except at one 
or two points, this examination, taken in connection with 
the history of the case and the smarting, burning pain in 
passing water, is very good evidence of fissure, if there is 
an absence of other conditions calculated to cause these 
symptoms. The pain in urinating caused from inflammation 
of the urethra, fissure, and laceration, is smarting, burning, 
or cutting. The pain from cystitis and urethral polypi, is 
bearing down, straining, with frequent desire, and unrelieved 
feeling after the water has passed. 



448 EATON ON DISEASES OF WOMEN. 



Prognosis. 

The prognosis is hopeful; when proper treatment is em- 
ployed urethritis may recover without special treatment. 
The other diseases of this canal are not likely to do so well 
if let alone. We know of no difficulty to w T hich women are 
liable, which is likely to be so poorly or improperly treated, 
and hence many a case supposed to be inflammation of the 
bladder goes on for years unrelieved. 

Treatment. 

The treatment of simple urethritis is much the same as for 
cystitis, as regards the indicated remedies. They are Can- 
thar., Cubeb.,Acon., Bell., Can. ind., Cal. carb., Bry. 

Aconite being indicated for the acute attack, with dizzi- 
ness, a wiry pulse, aching of the bones, etc. 

Bell., where the disease is recent, and there is dullness 
of the intellectual faculties, tenderness over the lower part 
of the abdomen, etc. 

Bryonia, when the disease is accompanied with evidence 
of general affection of the mucous membranes throughout the 
system, with cutting pains, sharp, piercing pains, etc. 

Cubebs, Canthar., or Can. ind., where the disease is 
chronic. 

Cal. Carb. where there is a leucorrhoeal complication. 

Caruncles, or the irritable urethral carunculw, are to be 
treated much like piles about the anus. The local application 
of Calendula or Hydrastis wash, applied warm by means of 
soft cloths saturated and applied to the parts, gives much 
relief, as does Bell, ointment. Hamamelis, externally and inter- 
nally, is also an excellent remedy. 

The polypi in the urethra, if protruding from the external 
meatus, may be seized with forceps, and removed by torsion, 
always having ready the Ferri persulph. to apply with a roll 
of cotton, or some other convenient means, in case much 



DISEASES OF THE URETHRA. 449 

hemorrhage follows the operation. If these polypi are en- 
tirely within the urethra, we dilate the canal as gently as 
possible, till we can seize and remove them by torsion as 
before. 

Lacerations of the urethra from accident, or from forcible 
distention, may require the local application of hcemastatics 
to arrest the hemorrhage ; and placing a gum elastic catheter 
in the bladder to keep the urine from coming in contact with 
the raAV surface, is a desirable means of obtaining healing 
by first intention. Internally Arnica is a useful remedy in 
these cases. 

Ulceration in the track of the canal of the urethra, if 
syphilitic, must receive treatment such as is given chancre 
in other localities. The non-specific sore or ulcer is to be 
stimulated by local applications of a Solution of Iodine, two or 
three grains to the ounce, and then leaving for a time a tent 
smeared with Vaseline in the urethra, using these applications 
every one or two days. To treat readily these ulcerations 
and internal polypi of the urethra, as well as fissures at the 
meatus interims, we dilate the urethra with sponge tents. 
These may be medicated with advantage, and should be 
long, so as to dilate the entire canal. Htjdrgr. chlo. mit. 
is a fine application to the ulcer or fissure in this tube. 
The powder may be sprinkled upon the tent after it is 
moistened with Glycerine, and applied directly to the affected 
part by inserting the tent. The tent should not remain 
more than two hours before it is removed. Internally, Merc, 
cor., Kali idro., Thuja, Cal. carb., Sulph., etc., are usually 
indicated. (Oanthar., Cubeb., etc., are of little or no use in 
these cases.) 

When we are unsuccessful by these means in curing the 
fissures of the neck of the bladder we may resort to an arti- 
ficial vesico-vaginal fistula, which we have described in con- 
nection with the treatment of chronic cystitis. 

In the case of fissures, they should be freshened when 

29 



450 EA TON ON DISEASES OF WOMEN. 

they can be brought into view through the fistula; or, we 
may apply the sharp point of a stick of Argentum nit. to the 
bottom of the fissure every three or four days; or, apply 
the Hydrgr. chlo. mit. dry to them by means of a sound 
wrapped in cotton. Generally there is some chronic cystitis 
in these cases, and the injections of warm water, with castile 
soap in it, passed through the fistula daily, are of much serv- 
ice. When the fissure and cystitis are cured, place a catheter 
in the bladder through the urethra, and let the fistula heal 
if it will. If we find it will not heal in a few weeks we 
freshen the edges, and stitch them together, as in an ordinary 
case of vesico-vaginal fistula. 



TUBERCULOSIS OF THE VAGINA. 451 



CHAPTER XXXIX. 

TUBERCULOSIS OF THE VAGINA— STENOSIS OF THE UTERUS. 

Tuberculosis of the vagina is worthy of but little remark, 
as but two cases are recorded, Virchow mentioning one and 
Klob another. In these cases the disease was associated with 
tubercular deposits in other parts of the body. Tuberculous 
deposits in the vaginal membrane may sometimes be diag- 
nostic of the real difficulty in disease of the liver, urinary 
organs, or bowels, which would otherwise be harder of diag- 
nosis. They may also teach us how the tuberculous ulcer 
develops, and possibly in time may aid in suggesting the 
proper treatment in tuberculosis, which is to-day very un- 
satisfactorily treated by all schools. 

Symptoms. 

We have in tuberculosis of the vagina the general symp- 
toms of tubercular disease affecting other parts of the body, 
most prominent among which are the tuberculous cachexia, 
evident faulty nutrition, the sallow, pale hue of the skin with 
a bright flush on the cheek, the hopeful state of mind, etc. 
Locally we have a feeling of irritation in the vagina. On 
examination indurated spots are felt like the eruption in 
small-pox. After several weeks or months these hard nod- 
ulated spots soften and burst open, and an open ulcer is the 
result, 

Prognosis. 

The prognosis is, in the present state of our knowledge, 
unfavorable, though life may continue for years. 

Treatment. 

Phytolac. Dec, loci of Ars., Merc, tod., Ars. alb., etc., are 
the indicated remedies. Locally a weak solution of Iodine 



452 EATON ON DISEASES OF WOMEN. 

applied with a soft brush every day, using warm water vag- 
inal injections once or twice a day, are useful; giving good 
nourishment and allowing the purest air, with frequent bath- 
ings with salt tepid water, and rubbing the surface of the 
body with the naked hand are found to be the most useful 
hygienic measures which can be instituted, conjoining with 
these moderate exercise in the open air. 

Stenosis of the Uterus. 

Description and Etiology. 

Stenosis of the uterus may be congenital or acquired. 
The seat of constriction is usually at the external os in 
stenosis, rarely at the internal os; occasionally it affects the 
entire cervical canal, while in flexions of the uterus there 
is very often constriction at the internal os only. Stenosis 
may be caused from inflammatory action in the virgin 
state, or be caused after one or more gestations, from in- 
flammation of the cervix and narrowing of its canal, espe- 
cially, when the preceding labor has been severe, or it may 
result from the use of caustics or instruments passed into 
the cervix to cause miscarriage, or for other purposes. Lac- 
erations of the cervix in labor may heal so as to cause 
stenosis. Many cases supposed to have been congenital may 
have resulted from inflammation in the cervical canal in child- 
hood or early youth. 

Diagnosis. 

Where the disease is congenital, or has resulted from 
some cause in early life, the cervix uteri is felt projecting 
more sharply than natural into the vagina, and the os is felt 
as a very slight indentation, or not felt at all. The eyesight 
in some cases can scarcely discover the os when the cervix 
is brought into view with the speculum, and we find that 
only a small probe will enter the os. In stenosis coining 
on later in life, after one or more confinements, the os is 



STENOSIS OF THE UTERUS. 453 

felt a little more open than already described, but upon at- 
tempting to pass the sound we are baffled, and find that 
only a small probe can be introduced. These are the positive 
diagnostic symptoms of stenosis. Dysmenorrhea is a symp- 
tom indicative of stenosis, although in a few cases where 
the flow is moderate the blood may find its way out without 
causing much pain. In the married, sterility is a symptom 
that may lead us to suspect stenosis, whether there is dys- 
menorrhcea or not. 

Prognosis. 

This is not grave in but few instances, and only then as 
it tends to cause complete atresia of the cervix, and wears 
out the patient from painful menstruation. By means of 
dilatation we may expect complete relief, not only to the 
dysmenorrhoea, but the sterility as well. 

Treatment. 

Remedies. — These are Secale cor., Puis., Bell., etc. In the 
majority of cases dilatation by mechanical means is our only 
resort. Various measures have been devised for this pur- 
pose. Some incise the cervix with an instrument called a 
metrotome or hysterotomy (See page 145.) Others dilate 
the cervical canal forcibly and almost instantly with a dilator 
with two blades. Some dilate and incise at the same time. 
My own preference is, however, for dilatation with bougies 
till we are able to insert a sponge tent, and use that, to ac- 
complish a, free dilatation, and at the same time dilate grad- 
ually ; by this means I have been very successful in relieving 
the dysmenorrhoea, and in many cases who married, or who 
were already married, pregnancy afterwards resulted. Of 
course, the usual care necessary in introducing sponge tents 
in any other case must be observed. 

I protest against incising the cervix in these cases. 
Incision without dilatation is a fraud. The incised surfaces 
are bound to heal and form a cicatrix, wmich makes the latter 



454 EATON ON DISEASES OF WOMEN. 

condition worse than the first, unless the parts are kept 
dilated till healed. With incision, there is more risk of 
inflammation and septicaemia following. 

If the stenosis is complicated with elongation of the 
cervix to a great degree, it is best to amputate a part of the 
cervix at once, taking care to insert a tent into the os during 
the healing of the cervix. (See page 169.) The amputation of 
the elongated neck may remove all the constricted portion of 
the cervical canal, and consequently make dilatation unneces- 
sary. Treatment by means of bougies alone will usually 
prove curative. The treatment must be carried to the ex- 
tent of being able to introduce a very large size. Gradual 
dilatation by bougies or sponge tents is in accordance with 
nature, and is to be preferred, in all cases, in my opinion. 
The cicatrix formed after incision, even when it is made suc- 
cessful by dilatation, greatly endangers laceration of the cervix 
in labor if pregnancy should ensue, and it is to be hoped that 
incision of the cervix, as a rule, in cases of stenosis, will soon 
fall into merited disuse. 



CYSTITIS IN WOMEN. 455 



CHAPTER XL. 

CYSTITIS IN WOMEN. 

Cystitis, or inflammation of the bladder, is not peculiar 
to women; but some of the causes which give rise to this 
disease in women are peculiar to them, and particularly 
interest the gynaecologist. 

Symptoms. 

Among the first and most prominent symptoms of cystitis 
is painful micturition, with a frequent desire to pass water, 
which is accomplished with much straining and difficulty, 
the water being passed drop by drop in some cases. Soon 
in the history of the disease mucus is thrown off from the 
lining membrane of the bladder in large quantities. This is 
tenacious, and adheres to the bottom of the vessel in which 
the urine stands for any length of time. Sometimes streaks 
of blood are mingled with the mucus. 

These symptoms, together with a wiry pulse, some fever, 
or alternating chill and heat, loss of appetite, constipation, 
and headache, characterize a case of acute cystitis ; but the 
disease often becomes sub-acute and chronic, in w T hich case 
the symptoms moderate in intensity, although the mucus 
discharged is often very large in amount. 

Etiology. 

The causes which produce cystitis which are common to 
both male and female are cold, external violence, irritating 
qualities of the urine, stone, gravel, etc. Those causes oper- 
ating in women only, are retro-version, ante-version, and ante- 
flexion of the uterus, long continued pressure of the head 



456 EATON ON DISEASES OF WOMEN. 

of the child in confinement, extension of inflammation from 
the uterus, ovaries, or cellular tissue in cellulitis, or from 
peri-metritis. 

When cystitis is caused from displacements of the uterus 
the irritation generally commences in the urethra, and extends' 
over the entire bladder if not arrested. In this case it is pro- 
duced from the pressure of the uterus against the urethra be- 
hind the pubis, causing a frequent desire for micturition. In 
some cases this is the most prominent symptom which the 
case presents of ante-flexion or ante-version. I will relate 
one case, which is an example of many I have seen. 

Mrs. , a very wealthy lady of this city, mother of 

four children (youngest nine years of age), native of Ger- 
many, of robust constitution, aged about thirty-four years, 
consulted me eighteen months since. She stated to me that 
soon after the birth of her last child she had commenced to 
be troubled with frequent desire to pass water, that she had 
been under treatment almost constantly ever since without 
getting any relief; for upwards of three years a prominent 
physician of Cincinnati had the treatment of her, and that 
she then went to Philadelphia and New York, and finally to 
Paris and Vienna, where she had employed those physicians 
of greatest celebrity. She felt entirely discouraged, having 
endured the severest ordeals, all having addressed their 
treatment to the relief of cystitis. Every thing had ap- 
parently been done, which her physicians could think of. 

She came to me with her husband, who seemed to deeply 
sympathize with her, and who told me that on account of 
my having cured a friend of theirs of a chronic ailment they 
had concluded to try again to see if any thing could be done, 
the matter of expense being no object. I proceeded to make 
an examination, and found a condition of chronic sub-acute 
inflammation of the bladder, and besides that, and causing 
the trouble, an ante-verted uterus, firmly pressed down by a 
pendulous abdomen. I proceeded to raise the abdominal 



CYSTITIS IN WOMEN: 457 

viscera with n silk elastic abdominal supporter, and in a few 
days replaced the uterus; gave internally Cantharides 6 X for 
a week, and then Can. ind. 3 s for a week, and then Nux 6 X . 
She fully recovered in six weeks, and remains well yet. 
The ante-version of the uterus was clearly the cause of the 
cystitis in this case, and it had been entirely overlooked. 
I should remark, in excuse for the oversight, that the lady 
had no backache, and menstruation had been easy, normal 
in amount, and regular. 

Treatment. 

Cantharides, Can. hid., Cubebs, Copaiba, etc., are the re- 
medies for chronic cystitis, after removing the exciting cause, 
which is of the first importance in all cases of this as well as 
other diseases. In acute attacks of cystitis caused from cold, 
Aconite, Puis., or Bell., are chiefly indicated. 

In acute attacks, caused from external violence, or from 
the pressure of the head of the child in confinement, Aconite 
and Arnica are the remedies needed. 

Of cystitis caused from stone in the bladder, I will speak 
in the next chapter. 

When caused from the irritating qualities of the urine, or 




W.F-.FORD 

Fig. Xo. MS. — Reversible Catheter. 

gravel, the analysis of the urine will reveal the remedies 
needed. In some cases it is found that remedies to chemic- 
ally change the constituents of the urine are demanded; at 
other times this may be accomplished through improved di- 
gestion and assimilation. Works on renal diseases should be 
consulted in these cases. 

Locally we sometimes obtain benefit in chronic cases from 



458 EATON ON DISEASES OE WOMEN. 

washing out the bladder by means of a Davidson's syringe, 
attached to a reversible catheter. (See Fig. No. 46.) The 
object of this washing is to remove the thick mucus or pus 
from the bladder, and perfectly evacuate all the urine, as the 
retention of the urine is a great source of irritation. This 
retention of the urine is occasioned by the blocking up of the 
urethra with this matter, causing tenesmus and a frequent 
desire to micturate ; for this injection clear tepid water, 
or water containing a small amount of castile soap may 
be used, and after the bladder is thoroughly washed out, a 
solution of about ten drops of carbolic acid to the ounce of 
w r ater may be injected, and enough used to slightly distend 
the bladder. This may be accomplished by stopping up the 
external opening of the double catheter. After the water is 
retained in this way about five minutes it may be allowed 
to flow away. Little or no good results from any kind of 
anodyne injections. They very often do not relieve the pain 
at all. 

In some extreme chronic cases, where the tenesmus is un- 
endurable, and the inflammatory action affects the kidneys and 
other abdominal organs, as well as the bladder, and remedies 
and injections prove of no avail, it is advisable to establish a 
vesico-vaginal fistula by operation, keeping it open till the 
cystitis is cured. By this means the free evacuation of the 
mucus, pus, and stale urine is accomplished, and we have 
access directly to the diseased surface. 

Operation. 

The operation for making a vesico-vaginal fistula is 
quite simple; still there are some practical hints which we 
may make for the benefit of the student. There is a space 
between the bladder and the vagina where they lie in direct 
contact, being separated by little or no cellular tissue; 
and on account of their near and intimate juxtaposition it 
is advisable to establish the fistula at this point, so as 



CYSTITIS IN WOMEN. 459 

to prevent the infiltration of urine into the cellular tissue, 
which would lead to cellulitis. This point is in the shape 
of a triangle with the base upwards, reaching from the ori- 
fice of one ureter to the other, the apex downwards at the 
commencement of the urethra. Within this triangle the an- 
terior wall of the vagina and the posterior wall of the bladder 
lie in contact. Just outside of the line of the ureters, which 
are about an inch apart, we have blood-vessels. These we wish, 
of course, to avoid ; hence the incision should be directly in 
the median line, and within the triangle just described. 

Having now some understanding of the anatomy of the 
parts, we proceed with the operation. The patient is placed 
upon the operating table, and the bladder made slightly 
tense by injecting into it tepid water; we now administer an 
anaesthetic, and lay the patient upon the left side. After 
this we introduce into the bladder a short, grooved staff, bent 
nearly at right angles, about four inches from the end which 
we introduce ; this is held in position by an assistant, when 
we dilate the vagina with a large-sized Sims' speculum, so 
as to bring into view the anterior wall of the vagina. We 
now insert the index finger of the left hand into the vagina, 
and by its side a sharp-pointed bistoury, with its edge di- 
rected backwards, held in the right hand. We now feel for 
the staff, and pierce the vaginal and vesical tissues at one 
thrust, till the point of the bistoury strikes into the groove 
in the staff about one and one-half inches from the meatus 
externus. We now press the bistoury upwards, keeping it 
firmly in the groove of the staff (first noticing that the staff 
is held in the median line), cutting upwards about an inch. 
We may now seize each side of the slit tissue with the for- 
ceps (after withdrawing the bistoury and finger), and with 
the scissors snip off a fourth of an inch or a little more from 
each side of the incised surfaces. This makes the opening 
more oval-shaped, and tends to prevent healing of any con- 
siderable portion of the cut surfaces. 



460 EATON ON DISEASES OF WOMEN. 

Usually there will be very little hemorrhage from the 
operation, if the directions I have given are closely followed. 
If, however, by accident the incision is made to the side of 
the triangle described, or is carried too far upwards, the large 
blood-vessels of the bladder may be wounded; they lie in the 
sulcus just outside the line of the ureters. Should we find 
that there is much hemorrhage, we should seize the bleeding 
vessel with the artery forceps and twist it around four or 
five times (this is called torsion) ; or we may apply the Pulv. 
Persulph. of Iron. If these means fail, we must apply a 
ligature to the incised vessel. 

This establishes a condition for the patient truly pitiable, 
't is true, but one of comparative comfort, by the relief which 
it brings in stopping the tenesmus, pain, burning, scalding 
and fever, and enables the general system to recuperate, and 
the bladder is relieved from the irritating qualities of the 
urine. 

Prof. Emmet,* of New York, is the first to have per- 
formed this operation. The idea was suggested to him by 
Dr. Sims. Prof. Parker had, however, in 1850 operated 
upon a similar principle for the relief of chronic cystitis in 
the male. Dr. Emmet operated on his first case in this man- 
ner in 1861. In 1858 Dr. Sims made the suggestion to leave 
a vesico-vaginal fistula open for the relief of cystitis. 

Dr. Bozemanf claims priority in this operation. He 
operated also in 1861, successfully. Dr. Emmet had carried 
out the principle in 1858 by advice of Dr. Sims. All seem 
to have obtained the idea from Dr. Parker's operation on the 
male performed in 1850. Professor Montrose A. PallenJ 
recommends opening the bladder in these cases with a red hot 
iron, called the Paquelin thermo-caidere. 

We are of the opinion that burning human flesh emits too 

5 Emmet's Diseases of Women, p. 728. 
tNevv York Jour. Obs., January, 1871. 
JAmer. Jour. Obstet, Vol. XI, April, 1878. 



CYSTITIS IN WOMEN. 461 

much the odor oP the dark ages, and we can wish for no 
return of their experiences. The object of using the hot 
iron is to prevent the closure of the fistula. It can be accom- 
plished by other means. In fact, it is not often very fast to 
heal if left to itself; and, as the treatment after establishing 
the fistula is to wash out the bladder freely by some means 
daily through the fistula, it is not likely to heal rapidly. We 
therefore dispense with the hot iron in toto. After curing the 
cystitis, which may take six months or two years, we close 
the opening, as in any ordinary accidental vesico-vaginal 
fistula. 

Indications for Remedies in Cystitis. 

Aconite. — Painful urging to urinate ; urine passes drop 
by drop, is scalding ; red or dark colored, with a hot, dry 
skin ; restlessness, etc. ; fear and alarm. 

Arsenicum Alb. — Blood in the urine; burning in ure- 
thra during micturition; involuntary discharge of urine ; gen- 
eral congestion; sad moods; cold, with hot flashes; thirst, etc. 

Belladonna. — Congestive condition; pain in the blad- 
der; flushed face; sense of fullness in the head; intoler- 
ance of light. 

Cannabis Indicus. — Painful micturition; large amount 
of mucus in the urine; mucus adheres to the vessel when 
cold ; excessive sexual desire ; general coldness of the body ; 
frightful dreams, etc. 

Cantharis. — Intolerable tenesmus in the bladder; cut- 
ting pains in the urethra; bloody urine; constant desire to 
urinate ; retention of urine. 

Copaiba. — Painful urging to urinate ; bloody mucus in 
urine, with dysentery ; pain in the ovaries, etc. 

Digitalis. — Constant urging to urinate ; great weakness ; 
itching all over the body; coldness of the skin, with palpita- 
tion of the heart. 

Pulsatilla. — Tenesmus in the bladder; urine very offen- 
sive, bloody and slimy, with amenorrhoea from cold. 



462 EATON ON DISEASES OF WOMEN. 



CHAPTER XLI. 

STONE IN THE BLADDER AND URETERS. 

Stone in the bladder is peculiar to no age or condition, 
cystin calculi being more common in the very young, and 
phosphatic calculi in those older. The uric acid calculi is the 
most common in the male and the phosphatic in the female. 

Without doubt, the condition of the urine has much to do 
with the formation of stone in the bladder, ureters, and pelvis 
of the kidney (where they are called gravel). These gravel 
forming in the pelvis of the kidney sometimes lodge in the 
lower part of the ureter, and increase in size by deposits from 
the urine ; or they may pass into the bladder. Gravel may form 
in the bladder primarily from the long continued retention of 
the urine, in cases where this secretion is heavily loaded with 
elements favorable to the formation of calculi; or they may 
form in the pelvis of the kidney, pass through the ureters 
into the bladder, and there increase by a sort of incrus- 
tation process from the deposit on their surface of the pecu- 
liar elements which are in excess in the urine. 

The effect of the imperfect evacuation of the bladder, 
from any cause, seems greatly to tend to the production of 
stone. Emmet* relates a case, occurring in 1868, who was 
paralyzed in her lower limbs from an injury to the spine 
caused by a fall. Four months after the fall urine began to 
escape per vaginam, and in a few days calculi enough 
passed this way to fill a large sized tumbler. He says, the 
condition of the bladder had been neglected, and it had been 
allowed to be distended for much of the time, and the urine 
being highly phosphatic, had given rise to the formation of 

* Emmet, Diseases of Women, p. 741. 



STONE IN THE BLADDER. 463 

calculi, which by their pressure upon the vesico-vaginal sep- 
tum had produced a slough (on account of the impaired vital- 
ity of the parts), resulting in the vesico-vaginal fistula, through 
which the urine and calculi passed. 

The formation of stone in the bladder has sometimes fol- 
lowed in a year or two after the operation for vesico-vaginal 
fistula; a bit of wire or thread which had been cut, but not 
entirely extracted, acting as a nucleus. Sometimes an irreg- 
ular adjustment of the tissues in the operation for fistula 
serves as a cause of the retention of a part of the urine, and 
favors the formation of calculi. 

In some cases, a calculus is the cause of vesico-vaginal 
fistula, it becoming wedged in between the pubis and the 
head of the child in labor causes a slough, which results in 
a fistula. The fistula might not be large enough to allow of 
the discharge of the calculus through it; and if it is closed 
by operation without an examination for stone, we will some- 
times find that a calculus is in the bladder; and it will be a 
surprise that the stone formed so soon, whereas, really the 
stone was there at the time of the operation, and was the 
prime cause of the fistula, as just mentioned. In view of 
this fact, I scarcely need mention the advisability of passing 
the finger into the bladder, and making a thorough exploration 
for a stone, before closing a vesico-vaginal fistula, which has 
resulted from labor. 

Symptoms. 

The symptoms of stone in the bladder are somewhat simi- 
lar to those in cystitis, in some cases, as stone in the bladder 
causes some irritation of the organ, and in so far would, of 
course, produce cystitis. In other cases, there is little pain, 
but the urine is obstructed in its flow, passing freely in a good 
stream for a moment or two, and then is suddenly arrested 
while the bladder is still distended. This is caused from the 
stone being forced against the meatus urinarius internus, so 
as to suddenly and completely close the orifice. 



464 EATON ON DISEASES OF WOMEN. 

Diagnosis. 

To make a positive diagnosis, we fill the bladder with 
water, after placing the patient upon her back with her thighs 
flexed upon the abdomen, the knees separated, and the 
patient placed under the influence of an anaesthetic, we 
pass into the bladder a steel silver-plated sound, when we 
may hear the click as the sound hits against the calculus. 
Placing the index and middle fingers of the left hand in the 
vagina and pressing against the bladder, may, in some in- 
stances, greatly facilitate the exploration. The distention of 
the bladder with water previous to the examination is im- 
portant, as otherwise the stone might be enveloped in the 
folds of a collapsed bladder, and we would fail to find it. 
The shortness of the urethra in women and the opportunity 
to press the bladder with the fingers in the vagina, make 
the diagnosis of stone in the female bladder comparatively 
easy. 

Treatment. 

The first thing in the treatment of stone in the bladder 
is to correct the secretions and excretions, and secure healthy 
digestion and assimilation; otherwise, if the calculus was 
removed, others would form in many cases. Citric acid is 
perhaps most frequently indicated. Sometimes the urine 
may be changed, Avhen chemically too acid, by the adminis- 
tration of alkalies, and when the urine is alkaline by giving 
acids. 

In some cases, where there is an excessive acid reaction in 
the urine, acids are beneficial in correcting the secretions ; and, 
secondarily, are useful in treatment. It is mainly in those 
districts of country where lime water is used for ordinary 
drinking and culinary purposes that acids have been found 
most beneficial in cases of stone or gravel (for gravel is very 
similar to stone in its etiology, the term stone being applied 
to those urinary calculi which are too large to pass by the 



STONE IN THE BLADDER. 465 

urethra ; and the term gravel is applied to small stones which 
pass by the urethra readily). 

The removal of stone from the bladder in women is not 
so difficult as in men, owing to the shortness of the urethra, 
and also owing to the great distension which the urethra in 
the female is capable of enduring. This facilitates the use 
of instruments for crushing the stone, and sometimes admits 
of its removal entire through this canal. This is the oldest 
method of removing stone, and in most cases the best. 
Some skill is needed in the manipulation, but no more, I 
think, than is required in other operations. The instrument 
used to crush stone in the bladder is called a lithotriptor. 
(See Plate VIII.) 

The operation for the removal of stone in this way by crush- 
ing is called lithrotrity. The operation through the vagina 
is called lithotomy. Extracting the stone without crushing 
it through the urethra is called lithectasy. In performing 
the operation of lithectasy it is generally necessary to first 
dilate the urethra-. This is accomplished with a sponge tent 
smeared with Belladonna ointment. The Bell, ointment takes 
away much of the sensitiveness of the parts, and is no im- 
pediment to the expansion of the sponge. Or, we may dilate 
the urethra with a three-bladed dilator, which is rapidly 
screwed up while the patient is under the influence of chloro- 
form ; or, a two-bladed dilator will do very well. (See for- 
ceps, Plate VIII.) 

Incision. — In some cases, where Ave find the urethra hard 
to dilate, we may aid the dilatation by incising the mucous 
and muscular coats of the urethra. The incision should be 
made downwards and outwards. We may safely dilate the 
urethra to the size of the index finger, and extract a stone 
about three fourths of an inch in diameter. 

The size of the stone may be determined by the distance 
the handles of the forceps are separated when seizing it,> 
having measured their expansion previous to being intro- 

30 



466 EATON ON DISEASES OF WOMEN. 

duced, while seizing different sized objects. In seizing the 
stone care must be used to move it from side to side, to be 
sure we". have not taken hold of a fold of the bladder as well 
as the stone. In extracting the stone we should use a rotary 
motion and not use direct traction. 

Should we find we have mistaken the size of the stone, 
and we are unable to extract it entire, we should let go with 
the forceps and introduce the lithotriptor, crush the stone, and 
wash the crushed pieces out of the bladder ; and, in case we 
find there are some pieces too large to be washed out we 
may extract them with the forceps, or again introduce the 
lithotriptor and crush again. In using the lithotriptor it is 
necessary to take great care not to seize a fold of the blad- 
der and crush that as well as the stone. 

A reversible catheter, of large size (see page 457), with 
both ends open fully, may be used to wash out the debris, 
pumping tepid soaped water into one tube and letting it flow 
out through the other. Dr. H. J. Bigelow* has invented an 
evacuating apparatus which fulfills all the requirements admi- 
rably. The apparatus consists of an elastic bulb with a glass 
tube at one end for receiving the fragments of stone, and at the 
other an elastic tube communicating with a large canula intro- 
duced into the bladder through the urethra. The bnlb is 
rilled with tepid soaped water, by pressing out all the air, and 
then placing the end of the tube in a basin of water (resting 
on a chair or table, and with the bulb on the floor). We 
then insert the canula, compress the bulb, and force the 
water into the bladder; then relax the pressure, and the fluid 
with some particles of the stone will pass out into the bulb. 
The particles of stone now gravitate into the glass tube be- 
low. We may now press upon the bulb and force the water 
again into the bladder, and again it is allowed to pass out 
into the bulb with other pieces of the stone, and so on. We 
are able to see in the glass tube how much of crushed stone 

*Amer. Jour. Med. Sciences, January, 1878. 



STOXE IN THE BLADDER. 467 

we have washed out, and also observe when no more is 
discharged. 

lithotomy. 

There are two approved methods of performing this opera- 
tion, the vaginal and the supra-pubic, the latter being re- 
sorted to in the male for the removal of stones of such 
extremely large size that they could not be removed by the 
perineal operation or by lithotrity. 

In women the ease of diagnosis of urinary calculi, together 
with the great dilatability of the urethra, will make it very 
seldom necessary to perform the supra-pubic operation ; be- 
sides, a very large stone may be removed by the vaginal 
method ; much larger than could be removed entire by the 
perineum in the male. 

If for any reason the supra-pubic operation is advisable 
in a case where we have atresia of the vagina as a complica- 
tion, or for other reasons, we make an incision about two and 
a half inches in length in the median line, commencing at 
the pubis, the bladder being distended with tepid water 
previously injected and a sound introduced by an assistant, 
or at least retained by him, and the urethra compressed to 
aid in the retention of the water. The sound carried up 
above the pubis will serve as an index to the point at which 
we should incise the bladder, having previously divided the 
attachment of the pyramidales and pushing upward the peri- 
tonaeum, and having the dissection carried through the cel- 
lular tissue. After a small opening is made in the bladder, 
we next enlarge it towards its neck, pass in the lithotomy 
forceps, seize the stone and extract it. While doing this it 
is well to have an assistant seize the edges of the bladder 
with small forceps on either side, and lift them a little out of 
the wound. 

After extracting the stone we should pass in the index 
ringer and feel for more calculi. Several calculi of large 
size are sometimes found in the bladder at the same time, 



468 EATON ON DISEASES OF WOMEN. 

and the oversight would be very mortifying, if we fail to 
extract them all at one operation. 

After extracting all the calculi, we draw off the water with 
the self-retaining catheter, which must be left in the urethra 
to allow the urine to drain away, and the use of a catheter 
not over three inches in length is most desirable (see Plate 
No. XIII), as, if it is longer, it might pass through the in- 
cision and fail entirely to perforin the intended service for 
which it is retained. Placing about two sutures of silver 
wire in the Avails of the bladder I consider preferable to 
leaving it open. One end of the suture wire may be left long, 
after the wire is twisted, and be brought out of the lower 
portion of the external incision. After four or five clays we 
can pass in sharp-pointed, strong scissors, and by a little care 
find the loop of the suture, cut it and withdraw the entire 
wire. After taking the sutures, as suggested, in the bladder, 
we close the external opening with interrupted suture and 
adhesive plaster, letting the plaster be applied first in strips 
about six inches long between the sutures, and then shorter 
ones over and between these, so as to completely cover the 
cut. In this way the short strips may be lifted up on the 
third day, the sutures removed, and the plasters reapplied. 

The vaginal method is easy of performance. A straight 
grooved staff is first passed into the bladder, the patient 
lying upon her side with the vagina distended with Sims' 
improved speculum. We then incise the anterior wall of the 
vagina and posterior wall of the bladder with a sharp-pointed 
scalpel at a point just above the meatus urinarius interims, 
pressing the point of the scalpel through the tissues till it 
reaches the groove in the staff, holding the edge of the 
scalpel away from the director, then slitting the tissues up- 
wards on the director an inch or an inch and a half, accord- 
ing to the size of the stone to be removed. We now with- 
draw the staff, pass the index finger of the left hand through 
the incision, then pass the forceps along the side of the 



STOiYE IN THE BLADDER. 469 

finger, and remove the stone, taking care after seizing it 
with the forceps, that we have not taken hold of a fold of 
the bladder as well. We may assure ourselves of this, by 
moving the forceps around in the bladder after we have 
grasped the stone, and making sure that we have it free in 
the forceps. If there is much hemorrhage, styptics must be 
used — first trying cold water, then ice, and if these are not 
efficient, we use the liquid persulphate of iron. After ex- 
tracting one stone, we must never forget to examine for 
others, and remove them also, if present. 

A catheter is to be now placed in the urethra and re- 
tained, and the incision closed by interrupted sutures, of sil- 
ver wire or silk, placed very close together — I think every 
quarter of an inch not too near — setting the stitches deeply 
enough to include all the tissues down to the walls of the 
bladder; and I prefer that two of them include the cystic 
walls also (it being very desirable to obtain union of all 
the incised tissues by first intention). The two sutures 
which we take in the cystic walls should be placed first, and 
the ends cut longer than the smaller sutures, so that they 
may be recognized and sooner removed than the others. 
These longer and deeper sutures should be removed on the 
fourth day, while the smaller ones may remain nine or ten 
days. 

Foreign bodies of almost any kind, like hair-pins, pieces 
of a stick or straw, when introduced into the bladder pro- 
duce irritation somewhat similar to a calculus. They soon 
become encrusted with phosphatic material, and serve as the 
nuclei for calculi, as I have mentioned before ; hence it is 
necessary to remove them soon, which can usually be done 
with the forceps (by exercising some patience and skill). 

Calculus in the Ueeter. 

Calculi have sometimes lodged in the ureters, and when 
of such a shape as to entirely block up the passage they 



470 EATON ON DISEASES OF WOMEN. 

produce more serious consequences than when they are sit- 
uated in the bladder. There is more backache, owing to the 
distension of the kidney with urine, which is secreted, but 
not expelled. There is a sense of weight and great ten- 
terness over the kidney and abdomen, conjoined with the 
symptoms present in cystic calculi. 

In these cases we may detect the stone with the sound 
at one time and utterly fail at another, on account of its 
projecting into the bladder at one time and not at another. 
The operation • for their removal is similar to that just men- 
tioned for ordinary lithotomy. It will be seen at once that 
lithrotrity is not applicable in these cases, as the lithotrite 
could not be applied while the calculus was lodged in the 
ureter. 

Treatment after the Operation. 

After the operation for the removal of stone has been per- 
formed, by either method, perfect quiet in bed should be in- 
sisted upon. After lithotomy the patient should continually 
lie upon the side — for four or five days at least — after litho- 
trity the position in bed is immaterial. After placing the 
patient in bed, Arnica 3 X should be given every hour for two 
or three days, unless the patient is asleep. If the pulse 
rises, and there is evidence of inflammatory action, Aconite 
should be given without delay. The patient should partake 
of the mildest nourishment for two or three days, after which, 
if no fever is manifested, more substantial food may be taken. 

Remedies for Stone in tlie Bladder, Gravel, etc. 

Aconite , Arnica, Ars. alb., Bell., Puis., Canth., Dulc, Can. 
sat., Nux v., Opii., Phos., Phos. ac, Cat. carl., Lycopodium, 
Sulph.yKali carb., etc., are sometimes useful. 

Aconite is indicated where there is restlessness, with 
fear, frequent desire to urinate, fever, thirst, nausea., etc. 

Arnica is indicated where the gravel passes with pain, 



STONE IN THE BLADDER. 471 

and is followed by bloody urine, burning in the urethra after 
the bloody urine has passed, etc. 

Ars. Alb. is indicated where there is alternating heat and 
cold, thirst, suppression of urine, etc; nausea; great weak- 
ness; aching in the lower limbs, or over the entire body; 
tongue coated white. 

Bell. — In suppression and retention of mine ; pain in the 
bladder; urging to urinate; pain in the back; flushed face; 
dullness of the brain; dilatation of the pupils; fever; dizzi- 
ness, etc. 

Puis. — From effects of cold at menstrual period, causing 
amenorrhea; suppression of urine ; painful micturition; mu- 
cus in the urine, with leucorrhcea, indigestion, loss of appe- 
tite, etc. 

Cantliarid.es. — In burning in the urethra; constant urg- 
ing to urinate ; pain in the back of the head and neck. 

Dulc. — Urine turbid; burning in the urethra; strangury; 
constant desire to urinate ; symptoms worse in damp weather. 

Can. Sativa. — Sharp pains in urethra; urine scanty and 
passed with burning pain; stitches in the urethra; mucus 
in the urine. 

Nux. — Painful urging to urinate; tenacious mucus in 
the urine; constipation, hemorrhoids, indigestion, etc. 

Opium. — Urine scanty, brown, or cloudy; retention of 
urine; dulness of intellect; face red and hot; constipation; 
cold sweat on the face and head. 

Cal. Carb. — Urine offensive, dark colored; profuse dia- 
phoresis; anxiety, with palpitation ; vertigo; deposit of earthy 
salts in the urine ; weakness ; in women of fair complexion. 

Liycopodium. — Gravel, with nephritis, or catarrh of the 
bladder; symptoms aggravated in the afternoon; red sand in 
the urine; flatulence, with pain in the abdomen. 

Sulph. — Worse after midnight; burning in the urethra; 
urine copious, offensive, excoriating ; violent itching in the 
rectum ; despondent mood ; fretfulness, etc. 



472 EA TON ON DISEASES OF WOMEN. 



CHAPTER XLII. 

SYMPATHETIC EFFECTS OF DISEASES OF THE UTERUS AND ITS 

APPENDAGES. 

There are certain affections that are dependent upon and 
caused by morbid conditions of the uterus and its append- 
ages, which are not properly considered hysterical, and 
deserve special mention. It has been my lot to see many 
cases of this character in my experience while resident physi- 
cian of the city hospital of Chicago in 1859 and I860, and 
since that in an extensive private practice, largely consisting of 
chronic ailments of women, as well as observations in consul- 
tation with other physicians, and in observing cases in hos- 
pitals in New York, Philadelphia, St. Louis, New Orleans, 
and Cincinnati. 

I am convinced that many sympathetic affections are mis- 
taken for special diseases, and the treatment of which is 
unsuccessful from a failure to discover the real ailment and 
remove the difficulty which exists in the uterus or append- 
ages. Patients in these cases w T ill sometimes give no inti- 
mation that they have any disease or difficulty of the uterus, 
either organic or functional ; and it is only by comparison of 
symptoms, the history of the case, careful examination of the 
patient, and differential diagnosis, as well as by much study 
and patience, that we are enabled to arrive at a correct diag- 
nosis in this class of cases. 

In some instances the patient will assert and insist that 
the uterine functions are normal, and that they are sexually 
perfectly healthy. This is sometimes owing to the modesty 
of the patient, and sometimes they do honestly believe they 
are well in this respect. They complain of want of appetite, 



S YMPA THE TIC A FFECTIONS. 473 

nausea, biliousness, constipation, headache, cold hands and 
feet, pain in the side, palpitation of the heart, amaurosis, 
painful or frequent micturition, sciatica, pain in the hip or 
ilio-sacral articulation, chilliness, hot flashes, pain in the top 
of head or occiput, pain in knee, ringing in the ears, languor, 
inability to swallow hard substances (caused from spasmodic 
irritation of the oesophagus, this being produced from uterine 
disease), sensation of some foreign substance (like a fish bone 
or pin) in the throat, cough, congestion of the lungs, liver, or 
other organs, anaemia, chlorosis, pruritus vulvae, etc. We may 
also have anaesthesia or hyperaesthesia, paraplegia or hemi- 
plegia, as sympathetic affections. 

When any or several of these symptoms are present in a 
case before us, and we can not find other reasonable expla- 
nation, we may look for the cause in the uterus or its 
appendages. 

It may be either organic or functional, the result of 
inflammation or displacement of the uterus, of tumors of 
uterus or ovaries, or even of an arrest of normal action, as 
seen in amenorrhoea, the peculiarity of these cases being, that 
in many of them they refer no pain directly to the parts or 
organs primarily affected. 

As I have mentioned under the heads of "inflammation;" 
" amenorrhoea," " displacements," etc., we have these symp- 
toms complained of sometimes ; but what I wish to impress 
upon the student's mind is, the fact that we may have these 
symptoms as a result of uterine disease, and have no sugges- 
tion from the patient of any uterine difficulty whatever ; 
and many times when inquiry is made, we are rather abruptly 
told that they are all well in this respect, intimating by voice 
and manner, at least, that they feel we might better have 
omitted the question. 

Years of experience will cause us to be persistent in 
ascertaining the true cause of these complaints; and espe- 
cially so when their history shows them to be chronic, and 



47-i EATON ON DISEASES OF WOMEN. 

that they have been subjected to much treatment without 
relief — the treatment I refer to being directed to the relief 
of the particular symptoms complained of, and not directed 
to the relief of the real cause of these symptoms. I believe 
I have seen patients complaining of all the symptoms above 
enumerated, which were caused by uterine disease or dis- 
placement, while the patient believed herself healthy in this 
regard. I will mention as examples two or three cases. 

In December, 1863, I was called to see Mrs. R., aged 
about forty years, widow of a prominent judge of Illinois, 
robust in appearance, light complexion, nervo-sanguine tem- 
perament. She complained of pain in one knee, and of 
inability to walk. She stated that she had been suffering 
for two years in the same way, and had had the best allo- 
pathic physicians in Chicago, who had leeched and blistered 
the knee, and she showed me a large iron splint they had 
recently used to straighten the limb, and again flex it by 
means of a screw. (I still have in my possession the appa- 
ratus as a curiosity.) 

On examination of the knee I determined that there was 
no trouble here, and I judged that the trouble was from reflex 
action produced from some trouble with the womb, and so 
stated to my patient, who rather indignantly replied, "I am 
perfectly healthy in that respect." I replied that if this was 
so, then I knew nothing of her case. 

I prescribed temporarily, and left her. In about two 
weeks she sent for me again, and stated that as I took an 
entirely different view of her case from her other physicians, 
she had concluded to employ me, and let me see if I was 
correct in my diagnosis. 

I accordingly proceeded to make a thorough examin- 
ation of the uterus, and found it as large as at three 
months in pregnancy, and retro-verted. On introducing the 
sound, which I did without hesitation (as her difficulty had 
been for two years troubling her with equal severity), I 



SYMPATHETIC AFFECTIONS. 475 

found a single polypus. I restored the position of the 
uterus, removed the polypus, and had the satisfaction of 
seeing her walk in six weeks without the aid of crutches 
or cane. I used no local treatment to the knee, no elec- 
tricity to the limb, no internal medication. I accidentally 
met her at the Southern Hotel in St. Louis in 1875, and 
she assured me she had had no trouble in walking since I 
had removed the tumor, twelve years before. She had never 
had pain in the pelvis, had menstruated regularly, and not 
too profusely. 

Such a case will not often be seen, but it goes to dem- 
onstrate the ideas I am trying to impress, that we may 
have serious uterine difficulties and have no complaint of 
pain in the organ, no interruption or excess of menstru- 
ation, and still have serious symptoms in other parts. Why 
we had no disturbance of menstruation in this case I am 
unable to say. Her strength of general system by inher- 
itance and education was far above the average, and may 
have been a reason why she suffered so little in general 
health ; and her decided assertion that she was perfectly well 
in all respects regarding her sexual organs, would have de- 
terred most physicians from insisting upon an examination 
of them; still, the result proved its necessity. 

Case Second, April 7, 1876. — Miss N., aged about thirty 
years, native of Illinois, was brought to me by her sister 
(whom I had cured the year previously of hemiplegia and 
loss of sight in one eye by restoring a retro-verted uterus), 
who stated to me that she had persuaded her sister to come 
to me from a distant city, that I might try to relieve her, 
though she had been treated by seven different physicians 
during the past four years, but that her trouble grew worse 
instead of better. The general appearance of my patient 
was good, excepting an inclination to be morose, and I caught, 
occasionally, the wild stare of the eye seen in the insane. 
She had an idea that she could not swallow any hard or 



476 EATON ON DISEASES OF WOMEN. 

solid food, and had subsisted upon milk, soup, and the like. 
She insisted that there was a fish-bone lodged in her throat 
so high up she was angry that no one could see it. In other 
respects she seemed to be in good health. Her menstruation 
was regular and normal. 

Although I at once suspected her complaints to be sym- 
pathetic, I concluded to make a thorough examination of the 
throat and oesophagus, which I did, and found no obstruction 
or difficulty. I gave some medicine to indicate my sincerity 
in my efforts to relieve her, and as an excuse that in the 
event of its failure to relieve her, it would be necessary to 
make a vaginal examination. Of course, the medicine failed; 
and with the combined persuasions of her sister and my own, 
she consented to a vaginal examination, which revealed a 
prolapse of the uterus almost complete. I restored and 
maintained the organ in situ, and in three days her difficulty 
of swallowing solid food had vanished. I attended to the 
case a little for about six weeks, when I found the uterus 
remained in position, and I dismissed her. I learned a year 
or more afterwards from her sister that she was still well. 
This patient might have deceived us in saying she had no 
pain of any kind, owing to her modesty. But I relate the 
case simply to show that we sometimes must investigate for 
ourselves in these obscure cases. 

These cases may serve as examples of reflex or sympa- 
thetic nerve action, though in the first case it might be 
claimed as direct nerve irritation from pressure of the en- 
larged and retro-verted uterus upon the nerves and ganglia 
in the pelvis; but why the manifestation in the knee? 

We speak of reflex and sympathetic nerve action. They 
are terms which signify a theory of nerve action, but are as 
incomprehensible as the term electrical current. We may 
study the phenomena of nerve action, and theorize upon them, 
but the whole matter is little understood. I am mortified 
in this, as in other things, at the little known by tfie pro- 



SYMPATHETIC AFFECTIONS. 477 

fession. Malaria, for instance; how often mentioned and 
blamed for its effects, but how little understood, never 
having been discovered by chemical analysis. There is still 
a wide field for investigation and discovery in physiology, 
pathology, and therapeutics, though in therapeutics Hahne- 
mann has discovered a law for the selection of remedies, 
which has already been of great benefit to mankind, and its 
advantages and reliability as a guide in treatment are bound 
to be universally acknowledged. Still, in this field we need 
more careful provings of some remedies, 

Treatment. 

In regard to the treatment of these various sympathetic 
affections, it may be readily inferred that no treatment is 
likely to avail except that which is directed to the removal 
of the cause, i. c, no other treatment is likely to be more 
than palliative; and he who can the most keenly discern the 
cause of these ailments will be the most successful in re- 
lieving them. 

One word just here, which I feel should be said in all 
kindness, and with due respect to the average practitioner. 
We feel that the habit which some have of denominating 
those ailments which they fail to comprehend nervous or hys- 
terical, and making no effort for their removal, is cruel and 
unbecoming the profession we represent. If after every in- 
vestigation no lesion or disease be discovered in the physi- 
cal frame, Ave may have to resort to the theory of nerve de- 
rangement, either functional or organic; still these poor suf- 
ferers demand, and humanity demands, the kindest and most 
considerate treatment at our hands. 

I might go into the detail of all the several sympathetic 
ailments I have mentioned, and many more ; but the treatment 
of all must have reference to the cause, and it is needless to 
go into the detail of symptoms, which may better be studied 
in our works on therapeutics, in relation to proper remedies. 



478 EATON ON DISEASES OE WOMEN. 

I have omitted to mention the mental affections produced or 
aggravated by uterine diseases. Some of them come under the 
head of Hysteria, others that of Insanity. Under Hysteria, 
and Puerperal Mania, may be found more extended remarks 
on the influence of uterine diseases upon the brain. 

Whether or not it is possible that uterine diseases should 
produce insanity, is to-day somewhat in dispute. We are in- 
clined to the opinion that they may, but whether it is a direct 
or reflex action, or in what way nerve irritation produces in- 
sanity, I will not attempt to explain further than to suggest 
that the pain experienced in some of these affections tends 
to exhaustion of nerve force as well as muscular strength, 
that the anaemic condition produced by the derangements of 
the functions of digestion, assimilation, and excretion (caused 
from uterine disease or otherwise) may seriously affect the 
brain substance, as well as tend to produce disease of its 
meninges. We are still, as a profession, greatly in the dark 
in relation to the pathological condition in insanity, and till 
we know more of it we are neither able to assert or deny 
theories of its causation. Still we see no good reason why 
diseases of the uterus may not cause insanity. I think we 
have evidence that they do, in the fact of the co-existence 
of insanity and uterine disease, and the fact that the men- 
tal aberrations disappear many times when the uterine diffi- 
culties are removed. Still this might have been a coinci- 
dence ; but there is no more reason to call this a coincidence 
than in many other diseases where the symptoms disappear 
when the uterine difficulty is cured. 

It seems to me in entire accord with the economy of na- 
ture that the brain should be affected by uterine disease, 
from the fact of the known influence of the brain upon ges- 
tation and the foetus itself as well, all the processes of 
nature, all glandular and muscular action being dependent 
upon nerve power. 

Hence it is reasonable to expect that disease or displace- 



SYMPA THET1C AFFECTIONS. 479 

ment of the generative organs, especially the uterus, might re- 
fleet an irritation back upon the great nerve centers. Hence 
we suggest that in mental derangements in women, we he 
very careful to ascertain if there is any uterine disease or 
deviation which might he a cause of the disturbance; if so, 
we will do well to rectify it in the commencement, if pos- 
sible. That the fretful nature of some women is sometimes 
due to uterine disease, we may be sure ; but as fretfulness 
is not classified as a disease, we will pass it by with the 
remark that if the symptom seems to need a remedy, we 
Avill keep in mind the possibility of its being caused from 
uterine disease. 

Before closing this chapter, I will call attention to a class 
of patients who are more of a wonder to me than those w T e 
have been considering. I refer to those who have complete 
procidentia, tumors of the uterus, etc., etc., and suffer no in- 
convenience worth mentioning. I know a lady now who has 
a polypus as large as a small hen's e^g attached by a pedicle 
to the moutK of the womb, and she suffers no inconvenience. 
Another had a cystic tumor of the vagina, which gave her 
no trouble, except as it interfered with sexual congress; 
several had complete procidentia who were perfectly well, so 
far as their feelings would indicate. So we see that con- 
ditions which will produce serious symptoms in one may not 
in another. Therefore we would gauge the necessity of treat- 
ment by the effects produced, and not by the actual condition 
present. After awhile the system seems to become tolerant 
of abnormal conditions, and they produce little trouble, in 
some instances, as I have mentioned. 

Electricity is a valuable agent, used in mild current, to 
tone up and strengthen the whole system, and especially the 
weakness consequent upon uterine disease. Mildness of the 
current, my experience confirms, is the most useful and de- 
sirable. Shocks are in my judgment injurious, the same as 
large allopathic doses, or as too low a potency of the indicated 



480 EA TON ON DISEASES OF WOMEN. 

remedy might be, and are to be avoided. The electro-mag- 
netic current I prefer. It is so generally applicable to weak- 
ness and loss of functional strength, I do not think it neces- 
sary to specify the minutiae of its applicability in these cases. 

Remedies. 

The remedies must be chosen from the totality of the 
symptoms, corresponding with their pathogenesis. They 
will be found in the cerebral and spinal groups. Among them 
the most useful are Aconite, Bell., Verat. viride, Camph., Can. 
ind., Ht/osc, Opi., Conium, Gelsem., Ignatia, Nux, Secede, 
Cimicif., Plat., Puis., Caul., Colcyntli., etc. They must be 
selected according to the peculiar correspondence of the 
symptoms in each case to the homoeopathic pathogenesis of 
the drug. 

If we should enter into the description of all the symp- 
toms which might arise, and name all the remedies which 
might possibly be applicable, this work would properly be 
termed a Materia Medica. We expect that the student will 
study the pathogenesis of remedies from works on Materia 
Medica, Symptomatology, etc. ; and understand, that when 
we name a remedy, we mean that it should be given in 
accordance with its homoeopathic indications. It takes too 
much time and space to continually repeat the pathogenesis 
of each drug. By naming the remedies we have found indi- 
cated most frequently, the student has a guide to the study 
of the remedies which are likely to be required. I do not 
say that possible complications may not arise, requiring other 
remedies, which the practitioner will, of course, have the judg- 
ment to use in case they are demanded. 

Hyperesthesia. 

Hyperesthesia may be local, i. e., confined to a small 
part of the body, or one side ; or may affect the entire body, 
as a result of uterine disease. In this condition the part 



SYMPATHETIC AFFECTIONS. 481 

affected exhibits no evidence of disease in itself, and its 
occurrence in connection with uterine disease or displacement, 
and its subsidence wlidn such disease or displacement is 
cured, is evidence of its dependence upon the uterine trou- 
ble as a cause. Patients so affected are almost thrown into 
spasms from the slightest touch. A striking and common 
manifestation of this condition is found in the supersensitive 
condition of a small spot beneath the left breast in women 
affected with congestion, displacement, or inflammation of the 
uterus. It does not occur in every case of uterine disease ; 
but I have never seen it exist without uterine disease; some- 
times one side of the entire body is affected by this hyper- 
sesthetic condition, and the opposite side and limbs remain 
of normal sensibility. I have seen this condition present as 
a result of both acute and chronic metritis. 

Etiology aaiai ^atliologry. 

This condition of supersensitiveness of the affected part 
seems to depend upon an inflamed and supersensitive condi- 
tion of the uterus. There may be in connection with this 
inflamed state some displacement or not. It sometimes occurs 
in connection with the sudden suppression of the menstrua- 
tion, which also causes congestion and inflammation of the 
uterus. Onanism may also produce hyperesthesia. 

The irritation of the uterine nerves causes irritation of 
the spinal cord through continuity of nerve tissue. Why 
this irritation is communicated to one side and not the en- 
tire cord we are unable to explain. It is one of the mysteries 
of nature as yet unsolved. This irritation is communicated 
to the nerves given off from the side of the cord affected; 
and hence the hyperesthesia of these nerves, wdiich are 
distributed to the opposite side, as those familiar with anat- 
omy will readily understand. This supersensitive condition 
is mainly exhibited in the extremely minute nerve filaments 
upon the surface distributed to the cuticle. 

31 



482 EA TON ON DISEASES OF WOMEN. 

Where only a small part of the body is affected by this 
supersensitiveness we find a theoretical explanation in the 
sympathetic or ganglionic nervous system. This system is 
so complex that it has not as yet been well understood. We 
can do little more than observe its complicated and astound- 
ing phenomena, and be aware of the sources from which they 
originate. 

This, however, is something. For at this point, and even 
before reaching it, scientists have to pause and acknowledge 
they can go no further. What does the astronomer do more 
than observe the motions of the various planets, and give 
names to the various constellations ? Why the planets re- 
volve in their regular orbits, and are sustained there, can he 
explain more than to say they do so in obedience to God's 
laws, or the laws of nature (in case he thinks himself so 
wise as to think it smart to discredit the existence of God)? 
What does the philosopher know of the laws of gravitation 
or cohesion? He knows from observation that these laws 
exist. Can he do more than name them, and describe their 
phenomena? Here we gain a little comfort in the fact that 
if we are quite ignorant of the exact action of the sympa- 
thetic nervous system, when we are able to note and appre- 
ciate their phenomena manifested through this system, we 
need not be ashamed in the presence of students of other 
departments of science, though we have accomplished much, 
very much, less than we desire. 

Diagnosis. 

The diagnosis of hyperesthesia is quite easy. The pa- 
tient usually gives us due and timely warning of the extreme 
pain she experiences from very slight pressure upon the 
affected part. This tenderness may be due to disease in the 
part, and it becomes our duty to ascertain if there is any 
disease of the portion of the body thus supersensitive. If 
so, of course, the diagnosis is made according to the local 



S YMF A THE TIC AFFECTIONS. 483 

affection. In case there is no local affection, no swelling, 
no redness, or heat of the part, we diagnose the case super- 
ficially as hyperesthesia. We desire, however, that the 
student should understand that we do not consider hyper- 
esthesia a disease, but simply one symptom of some dis- 
ease of the spinal cord, or of disease or displacement of 
the uterus. Hence, the diagnosis of the disease causing the 
hyperesthesia is quite another thing. I mention disease of 
the cord in this connection simply to guard the student 
regarding the diagnosis of the cause operating to produce the 
hyperesthesia, not to enter into the discussion of the diseases 
of the cord, further than to mention that some irritation is often 
produced in it, on account of uterine disease or displacement. 
The main affections of the cord the student will study in 
other works. We would have him always bear in mind that 
in the treatment of diseases of women spinal irritation, in 
slight or great degree, is a very common symptom, and that 
the symptom of hyperesthesia is particularly a symptom of 
the uterine origin of the spinal irritation in these cases. 

Prognosis. 

The prognosis in cases of chronic hyperesthesia (which 
term is applicable to those of many months' standing) should 
always be guarded. First, because the supersensitiveness 
may be so great that we may be precluded from making, at 
least for some time, any physical examination of the internal 
female genitalia, unless the use of anesthetics be brought in 
to aid us, which we can not always use for fear of their 
effects upon an already shattered constitution. 

Again, the difficulty of using the appropriate treatment, 
on account of the hyperesthesia, and on account of the friends 
of the patient failing to appreciate the nature of the case, 
and the necessity of uterine treatment, makes the prognosis 
less hopeful. 

Again, the prognosis should be guarded, on account of the 



484 EATON ON DISEASES OF WOMEN. 

possible existence of cellular, ovarian, or uterine irritation in 
the case, which we may at first overlook. 

Treatment. 

In some cases Hyoscyamus, Bell., Asafoetida, Pals., or 
Macrotis will give prompt relief if used according to their 
homoeopathic indications. The warm full bath, taken daily, 
is of some service in ahout all cases, though we would not 
claim it as sufficient to rely upon entirely in any case. The 
onanist should receive a liberal supply of Brom. in low atten- 
uation. As soon as possible we should ascertain if there be 
any displacement of the uterus, and if so, try to rectify it. 
If there is amenorrhoea, menorrhagia, metritis, cellulitis, 
ovaritis, or other disease in the pelvis these diseases should 
be treated as well as possible, according to suggestions given 
under their appropriate heads. 

Paralysis. 

PARAPLEGIA AND HEMIPLEGIA. 

Paraplegia is used to designate a condition of paralysis 
of a part of the body. It may be large or small in extent, 
affecting simply the muscles of one side of the face, or one 
or both of the lower limbs. 

Hemiplegia is a term applied to a paralysis of one-half of 
the body and one arm and one of the lower extremities cor- 
responding to the half of the body paralyzed. We do not 
find the arm upon one side and the lower limb of the oppo- 
site side simultaneously affected. Sometimes the muscles of 
the face are affected, and sometimes not. When affected 
they sometimes correspond to the side of the body paralyzed, 
and sometimes the opposite. In some instances sensation is 
perfect, and the power of motion is lost, and vice versa; in 
others, both sensation and motion are lost. These attacks 
usually come on suddenly without premonition. 



SYMPATHETIC AFFECTIONS. 4S5 



Etiology and Pathology. 

These attacks result from apoplexy, softening, or pressure 
upon the substance of the spinal cord, medulla oblongata, or 
brain, and from sympathetic action, or irritation in uterine dis- 
ease. It is only the latter cause which I desire to discuss in 
this volume. The process is somewhat similar to that which 
is present in the production of hyperesthesia, which I have 
already mentioned, with this difference, that while in hyper- 
esthesia there is irritation sufficient to cause tenderness of the 
nerve only, in paralysis there is irritation sufficient to cause 
some effusion under the membranes of the cord, and conse- 
quent pressure is exerted sufficiently to interfere with mo- 
tion, or both motion and sensation. Why one side is 
affected, and not both, is not easy to demonstrate. We can 
not explain this, any more than we can the periodicity ot 
intermittents. We simply observe that it is so. We have 
to acknowledge that there is a large field before us in the 
discovery of nerve action, Avhich is at present almost entirely 
in darkness to our short-sighted vision. Sudden suppression 
of the menstruation, or its delayed appearance from taking 
cold, I have seen develop hemiplegia, which lasted about two 
weeks, till the menses came on, and the inflammation of the 
w r omb had subsided. 

Diagnosis. 

We will suspect paraplegia or hemiplegia (from sympathy 
with uterine disease), when we find a paralysis of a part of 
the body ; and the history of the case excludes the probability 
of its being caused from apoplexy; and an effusion of blood 
beneath the membranes of a part of the cord, or medulla 
oblongata; or of its being caused by softening of the nerve 
substance of the cord itself. We are justified in making 
further examination to discover if there is any uterine inflam- 
mation or displacement in these cases. We may find both — 



486 EATON ON DISEASES OF WOMEN. 

quite certainly inflammation. Pain in the pelvis, and tender- 
ness over the lower portion of the abdomen, with some fever, 
and a wiry pulse, which is much more rapid than normal, will 
usually be found. Often the attack is ushered in by a dis- 
tinct chill. There may, or may not, be some incoherency of 
speech. Sometimes there is a hysterical condition in connec- 
tion with these cases. This is mentioned by Prof. Flint as 
" Hysterical Paralysis." Hysterical paralysis is transient, 
passings off very soon ; while paraplegia or hemiplegia, caused 
from sympathy with uterine disease, continues for weeks, or 
even months in some instances. 

Treatment. 

In the first place, attention must be given to treating the 
condition upon which the paralysis depends, and not to the 
paralysis itself; i. e:, let other symptoms be considered 
mostly in the selection of remedies. .In cases of sudden 
cold with chill, Gelsem., or Aconite in low dilution is usually 
indicated! Where chilliness and fever alternate every few 
minutes, or occur at the same time with thirst and nausea, 
Ars. alb. is the remedy. After the active inflammatory 
symptoms have subsided, Puis., Bell., or Macrotine is usu- 
ally indicated. In some cases, where there are sharp pains, 
Bry. or Cimicif. is indicated. Nux, China, Rhus, Baptisia, 
etc., may be indicated later. 

Locally the warm sitz or foot bath may be used, or the 
patient may at once be put into a warm pack. To give a 
warm pack, spread a pair of flannel blankets upon the bed, 
then wring a sheet out of very warm water and spread over 
the blankets ; now place the patient, divested of all her 
clothing, upon the sheet, and wrap the hot, wet sheet first 
snugly around her, and then envelop her completely in the 
blankets, pinning them tightly around the neck, leaving the 
arms alongside the body wrapped in the sheet and blankets. 
This pack usually causes profuse perspiration, and the patient 



SYMPATHETIC AFFECTIONS. 487 

may remain in it three or four hours, when she should be 
taken out and thoroughly rubbed with dry towels and re- 
placed in her clothing, having the temperature of the room up 
to about 80° for a time, though the air should be fresh by the 
admission of out-door atmosphere indirectly. The tempera- 
ture of the room may now be allowed to go down to 68° or 
70°. During the time the patient is in the pack, she may 
drink all (he cool water she may desire. 

On general principles the inflammation of the uterus or 
the displacements of the organ should be treated as in other 
cases where they occur. The hemiplegia or paraplegia will 
disappear as the uterine difficulty is removed. 

INDIGESTION, TYMPANITES, TORPID ACTION OF THE LIVER AND KIDNEYS 
AS SYMPATHETIC AFFECTIONS FROM UTERINE DISEASE. 

Imperfect digestion is one of the most frequent sympa- 
thetic affections of uterine disease. It very commonly results 
from suppression of the menstruation, from dysmenorrhoea. 
menorrhagia, displacement of the uterus, or inflammation of 
the uterus in either form, etc., etc. 

Tympanites is a result of this imperfect digestion. Torpid 
or deficient action of the liver and kidneys sometimes results 
from the prostration of the nerve strength, induced by uterine 
disease first affecting the digestion in many instances ; in 
others, affecting the spinal cord primarily, producing debility 
of nerve power. This weakness of nerve power then causes 
torpidity of all glandular action, notably in the liver and often 
affecting the kidneys; this torpidity of the liver, causing 
constipation, and tending to prevent complete digestion, also 
thereby causes tympanites. 

Treatment. 

NuX) Col.. Merc, iocl, China, Ars. iod.. Lycopodimn, Pids.. 
etc., are usually the indicated remedies ; though in inflamma- 



488 EATON ON DISEASES OF WOMEN. 

tory conditions of the uterus, Aconite, Bell., Gelscm, Verat. 
vir., Ars. alb., Br//., etc., may be required. 

Nux is indicated (sometimes in alternation with Col.) for 
indigestion with constipation, loss of appetite, pains in the 
small of the back, etc. 

Col. is indicated especially for sharp, twisting pains 
around the navel or in the colon, where there is gas in the 
intestines. 

Merc. Iodic!, is indicated by the lymphatic tempera- 
ment, sallow complexion, coated tongue, with torpidity of 
the liver and kidneys. 

China is indicated especially in case of menorrhagia, 
with debility, loss of appetite, etc. 

Ars. lodid. is indicated in the scrofulous diathesis, with 
loss of strength, insufficient flow of urine, with headache, in- 
digestion, etc. 

Puis, is indicated by loss of appetite, with amenorrhoea 
or dysmenorrhea, headache, nausea, etc. 

Lycopodium is indicated in constipation, with disten- 
sion of the stomach after eating, etc. 

Aconite is indicated when there is tenderness of the 
uterus or stomach, loss of appetite, inability to sleep quietly, 
fever, thirst, etc. 

Ars. Alb. is indicated by pains over the whole body, 
suppression of urine, thirst, alternate heat and cold, loss of 
appetite, etc. 

Bell, is indicated when there is tenderness of the uterus 
or ovaries, dull pain in the head, especially over the eyes, 
sense of weight in the pelvis, insufficient flow of urine, 
flushed face, tenderness over the kidneys, etc. 

G'elsem. is indicated by a tendency to congestion in any 
part, loss of appetite alternating with great desire for food, 
thirst, with alternate dry and moist skin. 

Verat. Vir. is indicated where there is tenderness over 



SYMPATHETIC AFFECTIONS. 489 

the entire abdomen, pain in the spinal cord, fever, thirst, pain 
in the stomach, etc. 

Bry. is indicated for constipation with mucous discharges 
from the bowels, vagina, etc., and in case of indigestion with 
sharp stitches in the side or head, tenderness of the scalp, 
sharp pains in the ovaries, pains in the limbs or back of a 
darting character. 

Of course, the most prominent indication is to cure the 
uterine trouble upon which these diseases depend. 



490 , EATON ON DISEASES OF WOMEN. 



CHAPTER XLIII. 

PUDENDAL HEMORRHAGE— PUDENDAL HEMATOCELE— THROM- 
BUS— RUPTURE OF THE BULBS OF THE VESTIBULE. 

Both pudendal hemorrhage and pudendal hematocele are 
of rare occurrence. Fatal cases have, however, been known. 
Simpson* records several cases where from slight rupture 
of one labium fatal hemorrhage resulted. 

Etiology. 

The causes of pudendal hemorrhage may be divided into 
predisposing and exciting. The predisposing cause is a vari- 
cose condition of the veins, which may be induced by preg- 
nancy or a large pelvic tumor. The direct or exciting cause 
is usually external violence, though Prof. Simpson reports a 
case clue to straining at stool. 

External violence may be received by the labia in falling 
upon some hard object or by the breaking of a pot cle chambre 
upon which the patient is sitting, or by receiving a blow which 
may cause an incised or punctured wound. When an incised 
or punctured wound is received, the hemorrhage may be free. 
When the external violence or muscular effort causes a rupt- 
ure of the veins of the part the blood is infused into the 
tissues, and a pudendal hematocele is produced, or as some 
term it, a Thrombus is formed, whiph is a very good term, 
signifying a coagulation of blood. 

The anatomy of the parts needs to be understood that 

we may appreciate the liability to these accidents in women. 

Around the vulva are situated a network of veins termed 

the Bulbs of the Vestibule, plexus of veins of the vestibule, 

* Obstet. Works, Vol. I, p. 277, Amer. ed. 



PUD EX DAL HEMORRHAGE. 491 

or pars intermedia. It is on account of the rupture of these 
veins around the vulva that the hemorrhage is so profuse in 
cases of accident to the labia or vulva. They may be acci- 
dentally ruptured in confinement from distension of the parts 
by the head of the child, or in the careless use of instru- 
ments in delivery. 

Diagnosis. 

The hemorrhage from the part in cases of incised or 
punctured wounds which penetrate deeply enough to injure 
the bulbs of the vestibule readily make the diagnosis clear, 

In cases of Thrombus or pudendal hematocele a sense of 
fullness, soreness, etc., is complained of in the labia, and on 
physical examination a tumor is felt, varying in size from a 
walnut to an orange, near the vulva and distending the labia, 
If recent, the tumor feels soft or semi-solid. If several 
weeks have elapsed, the tumor is rather solid in its feel, un- 
less suppuration has taken place, in which case the feel is 
fluctuating, accompanied with tenderness in the part, on 
pressure. 

Differential Diagnosis. 

Thrombus of the labia or pudendal hematocele is liable 
to be confounded with 

Abscess of the Labia, 
Labial Hernia, 
Inflammation of the Labia, 
(Edema of the Labia, etc. 
In abscess of the labia there must be a preceding history 
of inflammation of the parts — heat, tenderness, swelling, etc. 
In labial hernia, gurgling in the bowel, Avhich is pro- 
truded, the possibility of its replacement and its becoming 
smaller or entirely disappearing after lying clown several 
hours, distinguishes it from pudendal hematocele. 

In inflammation of the labia usually both are affected, 
and the swelling is more uniform, the tenderness and heat 
much greater than in thrombus or pudendal hematocele. 



492 EATON ON DISEASES OF WOMEN. 

In (Edema of the labia, both are usually affected. The 
entire labia are thickened and puffy, and there is no circum- 
scribed tumor as there is in pudendal hematocele. 

Prognosis. 

If the effusion of sanguineous fluid is small, it may disap- 
pear spontaneously by absorption. When the effusion is great, 
there is a liability of the formation of a labial abscess, and puru- 
lent infection may be feared, if the abscess is not freely evac- 
uated. Should there be a tendency to the formation of an 
abscess some degree of inflammation in the part will precede 
the development of pus, and the general system may largely 
be affected from this process — chilliness, fever, etc., are liable 
to occur, together with nausea, constipation, etc. In some few- 
cases the effused blood becomes encysted, and remains for years 
without producing any effect upon the general health, and 
Avhen of small size may inconvenience the patient but little 
or none at all. In pudendal hemorrhage there is usually no 
very great difficulty in arresting the flow of blood. 

Treatment. 

Pudendal hemorrhage may usually be controlled by the 
application of cold and compression. Cold wet cloths or 
pieces of ice may be firmly applied to the part by means of a 
T bandage. If this proves ineffectual in controlling the 
hemorrhage the Ferri Persulph. may be used and pressure 
continued. 

In pudendal hematocele of recent occurrence it is best 
to either freely evacuate the blood by incision and apply 
styptics, or evacuate with a trocar and inject through the 
canula some cold water, and apply compression as in a case 
of pudendal hemorrhage; and if hemorrhage continue after 
that, inject the liquid Ferri Persulph., well diluted, and 
again apply the compress. 

If an abscess forms either before or after the discharge 



PUDENDAL HEMATOCELE. 493 

of the blood, the pus should be freely evacuated. Brush out 
the interior of the abscess with a Solution of Iodine, and apply 
pressure to cause adhesion of the walls of the abscess. 

Thrombus or encysted blood-clot may be left to itself if 
small. When large, so as to greatly inconvenience the pa- 
tient, it may be enucleated by first incising the mucous tis- 
sue, and peeling out the entire tumor, using the fingers and 
the handle of the scalpel for this purpose. 

Remedies indicated in the hemorrhagic diathesis, or -for 
varicose veins, may be given as indicated by homoeopathic 
pathogenesis. 



494 EATON ON DISEASES OF WOMEN. 



CHAPTER XLIV. 

PUBERTY— AND THE CLIMACTERIC PERIOD. 

The age of puberty in girls signifies the time when ovula- 
tion and menstruation commences, though they do not always 
occur simultaneously, ovulation having been known to occur 
before the establishment of menstruation, as shown by 
the occurrence of pregnancy before the appearance of the 
catainenia. 

Just how frequently ovulation is established previous to 
menstruation it is impossible to determine (as but few are 
exposed to possible impregnation at this age). Still there 
are reasons to justifj^ the belief that ovulation precedes the 
appearance of the menstrual flow for several months in very 
many cases. The most prominent of these reasons is the 
uneasiness, pain, bearing down in the pelvis, sometimes accom- 
panied with backache and headache, nausea, etc., occurring-at 
intervals, sometimes irregular at first, varying from four to 
six or eight weeks, gradually becoming more regular in their 
recurrence every four weeks, when the flow also appears. 
In some cases, however, the flow comes on without these 
premonitory symptoms, which are indicative of ovulation^ 
either complete or imperfect. 

The development of this function is a critical period in a 
woman's life, a period when her whole being seems to change. 
The romping, rude girl becomes the reserved, modest young 
lady. The breasts develop, the whole form becomes rounded 
and symmetrical. The mental changes are about as marked 
as the bodily. Though tfuln ess and comprehension of deep 
subjects are manifested in place of the careless thoughtless- 
ness of childhood and want of understanding which usually 
mark the age of youth. 



PUBERTY. 495 

Generally this change takes place in girls at about the 
fourteenth or fifteenth year, sometimes coming on at twelve; 
or even at nine in warm climates, and is sometimes delayed till 
seventeen or eighteen years are attained in colder latitudes. 

During the intervening period from the time the symp- 
toms of commencing ovulation first appear to the time men- 
struation is regularly and fully established, various symptoms 
are manifested with which the student should become familiar ; 
for, otherwise, he might be led into errors, both of diagnosis and 
treatment, in frequent instances, entailing upon himself much 
ridicule (especially on the part of the old ladies), which might 
be remembered and told of him for many years. I will not 
discuss here the various theories regarding menstruation and 
ovulation, as this belongs more particularly in the department 
of physiology; but will consider the manifestations which this 
change develops in the system.' Dv. Emmet has occupied 
much space in giving tables indicating the age at which men- 
struation was developed, the barrenness or fruitfulness of 
each, etc., etc., which are of interest as statistics, but of no 
practical value; as the average' age of puberty is shown to be 
fourteen years, with a variation from ten to twenty-three 
years of age in exceptional instances. 

From all experience we learn that there is no exact time 
for the period of puberty to become established. It occurs 
earlier in warm climates than in cold; earlier in cities 
than in the country, owing to the greater excitation of the 
nervous system, often 'tis true at the expense of the 
muscular. Civilization and a luxurious mode of living doubt- 
less tend to the early development of this function. 

As ovulation commences the girl shows more irritability 
of temper, is peevish and fretful, restless and sometimes 
sullen; the appetite is capricious, longings for unnatural arti- 
cles, like chalk, slate pencils, etc., are common. Disorders of 
digestion are often manifested, eruptions on the skin appear, 
notably in the form of pimples on the face. Pain and tender- 



496 EA TON ON DISEASES OF WOMEN. 

ness in the lower abdomen, with painful micturition are some- 
times complained of, in connection with severe pains of a 
spasmodic character in the epigastrium or groins. These 
symptoms in the girl of suitable age, manifesting the some- 
what rounded form, with the growth of hair upon the mons 
veneris, and having no menstruation, we may conclude are 
indicative of retarded development of the menstrual functions, 
and we should treat the case accordingly. 

If neglected in this regard serious inflammation may 
supervene, and mental derangement is sometimes produced 
from this cause. Many cases of sterility, I believe, are due 
to the inflammation developed in these cases before the ap- 
pearance of the catamenia, causing thickening of the investing 
membrane of the ovary, disease of the endometrium, contrac- 
tions of the cervical canal, or occlusion of the Fallopian tubes. 

THE CLIMACTERIC PERIOD, OR MENOPAUSE, ALSO TERMED "THE 
CHANGE " AND " L'AGE DE RETOUR." 

These terms signify the time of cessation of the functions 
of menstruation and ovulation. This occurs about thirty 
years after the establishment of the function. Usually, 
when it commences early, it also terminates early, and vice 
versa. Exceptional cases occur where the term of menstrual 
activity is longer or shorter than thirty years. 

At the climacteric period the changes in the system are 
as marked and critical as at the development of puberty, and 
the dangers to health and life are as great, though from differ- 
ent conditions ; and the results are as serious, though of a 
different character. 

The cessation of the menstrual flow is sometimes sudden, 
but most frequently it becomes irregular as to length of 
intervals in its recurrence, as well as to time of duration and 
quantity discharged. This irregularity is sometimes mani- 
fested for a year or more before the flow ceases. 

Upon the first arrest, or suppression of the flow, the patient 



THE CLIMACTERIC PERIOD. 497 

usually suffers from the same train of symptoms as occur 
in cases of suppression from other causes earlier in life, but 
with less intensity; sometimes, however, for a few months, 
the arrest of the flow produces no serious disturbance in the 
system, and with a few women the change of life produces 
no effect whatever. These cases of exemption from disturb- 
ance in the system from cessation of menstruation are the 
exception; and it is usually found that a very considerable 
effect is produced, as might be expected, from the reten- 
tion in the system of more sanguineous fluid than it has 
been accustomed to. 

Generally, as a first effect of the menstrual cessation, the 
uterus may be felt congested and enlarged, and it is likely 
the ovaries and entire pelvic viscera are in a measure con- 
gested also. This congestion and over-fullness of the blood- 
vessels in the pelvis, especially in the uterus, causes irritation 
of the nerves of these parts, which is communicated to the 
spinal cord and sympathetic ganglia, which explains some- 
what the manifestations of diseases peculiarly common at 
this epoch. 

The train of symptoms sometimes developed includes 
almost if not all the sympathetic and hysterical manifesta- 
tions to which women are liable, as well as the actual 
derangement of functions which do occur in these cases. 
As perhaps the most common result of this congestion, con- 
tinuing for several months, we have profuse floodings, follow- 
ing several months of suppression. These floodings are in 
some cases very exhaustive to the system, and even danger- 
ous to life. 

The next most common disturbance in the system is 
derangement cf digestion, causing pain, colic, heartburn, etc., 
etc., accompanied sometimes with diarrhoea, and sometimes 
with constipation. Backache, headache, neuralgia in various 
parts of the body, sciatica, etc.. are very frequent at this 
period. This condition of congestion of the parts gradually 



498 EATON ON DISEASES OF WOMEN. 

gives place to atrophy of the uterus and uterine organs. The 
congestion continues for a time, and may result in chronic 
inflammation of some part of the uterus or ovaries, and the 
consequent development of ovarian or uterine tumors; or 
we may have a profuse leucorrhcea, which is caused from 
this irritation of the organs, and which for a time seems to 
be vicarious of the regular catamenia. Epistaxis, hemor- 
rhoids, etc., sometimes seem to relieve the system vicariously 
in recompense for the absence of menstruation. 

The effect of the climacteric upon the mind is sometimes 
marked. The patient is taciturn, fretful, forgetful, easily 
angered, changeable, sometimes exhibiting various forms of 
mental derangement, at other times manifesting a childish 
disposition, exhibiting a great love for shoAvy dress, and 
occasionally in widows causing an almost uncontrollable sex- 
ual passion, manifested in the most imprudent conduct and 
unblushing expression of a desire to marry, much to the 
mortification of friends and relatives. Sometimes the desire 
to bear a child in old age becomes so strong that she imag- 
ines herself pregnant. This condition is termed pseudocyesis, 
or false pregnancy. The increase of adipose tissue common 
at the climacteric period aids in the illusion, conjoined with 
the disorders of digestion so frequently present. The delu- 
sion is embraced as a sweet phantom, as an evidence of 
sexual vigor; and it is sometimes almost or quite impossible 
to disabuse her mind of her mistake. The cessation of men- 
struation, nausea, increase in size, as well as the movement 
of gas in the bowels (simulating movements of the foetus), 
all tend to confirm her wish that pregnancy might exist. 

Treatment of Conditions Arising- at I»utoerty. 

First, when the age and development of the patient in- 
dicate that puberty is reached, and there are present the 
various symptoms described, and there is no show of mens- 
trual discharge, Puis., Macrotis, Bell., Sepia, Aconite, Ars., 



PUBERTY— AND THE CLIMACTERIC PERIOD. 499 

China, etc., should be studied. Puis, or Macrotis are indi- 
cated for the non-appeafance of the menstruation without 
special symptoms for other remedies. Bell, is indicated for 
bearing down pains with tenderness of the epigastrium. 
Sepia, when the patient has a leucorrhceal discharge. Acon- 
ite, in case nervous symptoms predominate, with chilliness 
or fever. Ars. for nausea, complicated with hot flashes. 
China for weakness, trembling of the limbs, vertigo, etc. 

Attention should be given to these cases regarding dress, 
to see that they wear sufficiently warm clothing about the 
feet and limbs. Warm foot baths, or the warm hip bath, 
may often be of service. A useful adjuvant is found also 
in the mustard plaster to the small of the back and epigas- 
trium in case much pain is felt in these regions. Horseback 
exercise is often highly beneficial. 

If after several months of trial of remedies the flow is 
not established and the symptoms are of a serious charac- 
ter, and the patient having reached an age somewhat ad- 
vanced beyond that when the catamenia ordinarily appears, 
it is advisable to institute a sufficient physical examination to 
determine whether there is an imperforate hymen or an atresia 
of the vagina or cervix uteri, and, if so, to establish a normal 
condition. If the parts are found normal, we mast wait and 
continue the use of remedies, and place the patient in favorable 
hygienic conditions. Sometimes going into company is good 
in these cases, calculating to divert the mind and restore 
equilibrium in the nerve forces. Cessation from hard men- 
tal labor is in some cases a necessity, as the excessive ac- 
tivity of the brain may so divert the nerve forces in the 
system as to cause atony of the genitalia, as mentioned in 
treating of " Vaginismus " and " Amenorrhea." 

Treatment of Disorders of the Climacteric. 

For the condition of suppression of menstruation occurring 
in the married, we are debarred from very active measures 



500 EATON ON DISEASES OF WOMEN. 

on account of the possibility of the existence of pregnancy. 
In cases where we are sure pregnancy does not exist, we 
may use remedies as we would in an ordinary suppression, 
as mentioned under the head of °' Amenorrhoea," especially 
if the system seems to be suffering on this account. Gen- 
erally Aconite or Ars, alb. will be indicated in these cases, 
as they usually suffer from congestion in some part of the 
body, if they suffer at all; Ars. being indicated if there is 
congestion without fever, or if the fever is of short dura- 
tion, alternating with chilliness, thirst, restlessness, want of 
sleep, etc. ; Aconite being indicated when the congestion 
merges into an inflammatory condition, with fever, dryness 
of the skin, etc. Bryonia or Verat. vir. may be indicated 
if the pulmonary symptoms are marked, showing congestion 
in the lungs. The warm foot bath with warm applications 
to the epigastrium and small of the back are calculated to 
aid in establishing the equilibrium of the nerve force and 
the circulation of the blood as well. Gastric symptoms, in- 
digestion, constipation, etc., are to be treated as if arising 
from any other cause, with Ipecac, Puis., Nux, Sulph., etc. 

Should uterine hemorrhage set in, and be excessive, the 
recumbent posture must be maintained, cool drinks must be 
given, and all stimulants avoided. The remedies are Secale 
cor., Nux, Ipecac, Aconite, Bell, Trillium, Nit. ac, China, 
etc., choosing the one whose pathogenesis most closely re- 
sembles the case in hand. I have named remedies in the 
order in which I have found them most frequently indicated. 

This class of patients should be treated with great con- 
sideration, not only on account of their difficulties, but on 
account of their age and the delicacy and solicitude the pa- 
tient always feels regarding her condition at these times. 
She should not be disputed with or opposed more than it is 
impossible to avoid. Her idiosyncrasies should not be men- 
tioned by her friends to others in her presence, as at this 
period the lady is often over sensitive about the good opin- 



PUBERTY— AND THE CLIMACTERIC PERIOD. 501 

ion of her acquaintances, though she may pretend to ignore 
and despise the opinions of others, and does not like to think 
that old age is approaching. She does not like, therefore, to 
be told that this is the climacteric period with her. 

It becomes the physician's duty to enjoin great care on 
her part to avoid taking cold ; and exposure to damp, cold 
atmosphere, especially at night, as well as fatigue, should be 
avoided. My opinion is that often the menses disappear 
before the climacteric period is reached, on account of various 
causes independent of the natural cessation of ovulation and 
consequent stoppage of uterine activity; hence, it is the plan 
most conducive of good to our patient to keep up the function 
of menstruation as long as possible. In this way I think 
much of the tendency to the development of uterine tumors, 
cancer, phthisis, etc., is avoided by maintaining the function 
of regular menstruation as long as possible, and much of the 
liability to excessive hemorrhages is also avoided. We also 
have less development of nervous symptoms, digestive de- 
rangement, etc., if the function is maintained regularly to the 
utmost limit. When this is accomplished the system will 
suffer little from the absence of menstruation. The sexuality 
is, in a measure, lost; sexual passion is lost, or much weak- 
ened, and the uterus becomes atrophied ; the vagina shrinks 
and becomes dry. Under these circumstances the only symp- 
tom likely to develop will be weakness, showing a loss of 
vitality as w T ell as virility. In these circumstances Nux 9 
China, Ars., etc., are usually the indicated remedies. 



502 EAl'ON ON DISEASES OF WOMEN. 



CHAPTER XLV. 

ATRESIA OF THE VAGINA, AND CERVIX UTERI— HMMATO- 

METRA, ETC. 

Closure of the vagina or cervix uteri may result from 
adhesive inflammation from cold or from traumatic lesion, or 
it may be congenital. In these cases of absence or atresia 
of the vagina the menstrual blood sometimes finds exit 
through the rectum and sometimes through the urethra. 

In some of these cases, where the os uteri has opened 
into these canals, pregnancy has resulted when these canals 
have been used for copulation.* Generally, for some reason, 
the urethra is relaxed and greatly enlarged in cases of atresia 
of the vagina. Dr. Emmet f mentions the case of a young 
woman who, after being married several years without a men- 
strual flow, was found to have copulated with her distended 
urethra, and neither her husband or herself had suspected the 
true condition. 

After opening up the vagina the urethra usually con tracts 
to a normal size. The closure of the vagina must, of neces- 
sity, cause a retention of blood in the uterus ; and this con- 
dition is called hcematometra. In cases where vicarious 
menstruation is not otherwise established, sometimes hseinat- 
emesis, haemoptysis, or epistaxis seem to take the place of 
the catamenia and become vicarious menstruations; at other 
times hemorrhage from the rectum takes place as a vicarious 
menstruation, when there is no communication between the 
uterus and bowel. 

The occlusion may exist as a transverse septum in the 

■"'Barnes' Diseases of Women, page 203. 

t Emmet's Prin. and Prac. of Gynaeology, page 207. 



ATRESIA OF THE VAGINA. 



503 




Fig. No. 47. 

Atresia of thic Vagina 

with HjEMatometra. 



vagina (see Fig. 47), or it may affect the lower portion only, 
or the os uteri externum or internum may be the seat of the 
occlusion, or it may affect the entire cervical canal. Either 
condition may develop hsematometra, which 
will be situated above the location of the 
adhesion. 

Professor Emmet* relates a case of 
double uterus and vagina with atresia of 
one of the vaginae. (See Fig. 48.) He 
says : " Some years since I was consulted 
by a woman about nineteen years of age, 
who had never menstruated regularly, and 
wished relief from a sense of pressure and 
bearing down which had existed for several 
years. She was exceedingly nervous ; I 
had great difficulty in completing a thor- 
ough examination, and was not a little puz- 
zled to make out a diagnosis. To the left of the vagina was 
felt an accumulation of fluid extending as high as the finger 
could reach, and from the rectum an 
elastic and nearly globular body could 
be felt, closely attached to the uterus. 
After satisfying myself as to the posi- 
tion of the fluid and its connection with 
the uterus, I unfortunately suggested to 
introduce an exploring trocar, to ascer- 
tain the character of the accumulation. 
It seemed I had already lost my pa- 
tient's confidence, from the length of 
time I had taken to form an opinion as 
to Avhat her difficulty was, so that my f.g. 48. 

m Doublk Uteri-s and Vagixa, 

proposition was refused!, on the ground one vagina closed. 
that she would not be experimented with any longer. I never 
saw the case again, and know nothing of her subsequent 

* Emmet's Prin. and Prac. of Gynaecology, page 208. 




504 EATON ON' DISEASES OF WOMEN. 

history." Dr. Emmet claims this as a case of double uterus 
and vagina; but the symptoms he relates might be produced 
by hsematocele; hence the cut and diagnosis both draw upon 
the imagination. 

The doctor might have beenright in his diagnosis; he had no 
opportunity to confirm it. He relates, on page 209, a case 
which he saw with Dr. Watts, in Roosevelt Hospital, where 
there existed a sinus which passed up by the side of the 
vagina, and communicated with the uterus. There was but 
one uterus, and these two outlets were converted into one by 
dividing a thin septum. The doctor assumes a, similarity in this 
case to the one first related ; and, therefore, claims the first 
as a case of double uterus and vagina, mainly because the 
menstrual flow was irregular, occurring not less than eight 
weeks apart, hence concluding that the menstruation occurred 
one month into one side of the double uterus, and the next into 
the other. He claims this without knowing positively that 
there existed a double uterus or atresied vagina in the case. 
Abnormal developments should have a better basis of fact to 
stand upon than this. 

Etiology of Atresia of twe "Vagina and Cervix Uteri. 

Congenital malformation nmy present this deformity, but 
it is more frequently the result of a cicatricial process from in- 
flammation, sloughing, ulceration, or laceration; or it may 
result m the vagina, or os uteri, from the use of caustic appli- 
cations, causing adhesive inflammation, or from inflammation 
following labor. Hokitansky describes a sort of concentric 
occlusion resulting from advancing senile atrophy. 

The os is also occluded from want of care to maintain the 
opening after amputation of the cervix. 

The external and internal os sometimes become occluded 
after the cessation of menstruation, and the mucous secretion 
of the endometrium accumulates within the uterus, causing 
nervous symptoms, which promptly vanish upon the re-estab- 



ATRESIA OF THE VAGINA. 505 

lishment of the normal passage. This has occurred in ray 
own practice, but I do not recollect it to have been men- 
tioned by any other work on Diseases of Women. Barnes 
mentions that in infants and young girls atresia of vagina and 
hymen may produce serious consequences, and require an 
operation, on account of the retention of the secretions above 
the adhesion. 

Abrupt flexions of the uterus may cause atresia at the 
internal os, when accompanied w T ith inflammation and exuda- 
tion, or granulation. The same may also result from the 
development of intra-mural fibrous tumors in the cervix, or 
lower part of the body of the uterus. Inflammation of the 
vagina in childhood may cause atresia; hence, cases of leu- 
corrhoea in young giris must not be neglected (as the Ieucor- 
rhoea is but a symptom of vaginitis, endo-cervicitis, or endo- 
metritis). 

Symptoms. 

In congenital atresia of the vagina or cervix uteri there 
is, of course, non-appearance of the catamenia. If the ovaries 
and uterus are normal the blood is effused, but retained above 
the point of the atresia, called hcematometra, and gives rise 
to the symptoms about to be mentioned; and in acquired 
atresia, hsematometra is a result. This arrest of menstrua- 
tion, or its entire non-appearance, must be present in every 
case of atresia, whether congenital or acquired (if the uterus 
and ovaries are normal). But the absence of menstruation 
does not positively indicate atresia, for it might be caused 
by absence of the uterus or ovaries, or want of action in 
these organs. 

A physical examination would show 7 the condition at 
once. If no obstruction was found in the vagina the attempt 
to pass the uterine sound would reveal the atresia of the 
cervix if it existed. Just here some care is necessary not to 
fall into an error in diagnosis, as a contraction of the cervical 
canal or a flexion of the uterus might offer much obstruction 



506 EATON ON DISEASES OF WOMEN. 

to the passage of an ordinary uterine sound. Generally, 
however, we will not feel it necessary to attempt this thorough 
examination till there is evidence of haematometra constituting 
a tumor of considerable size. 

At first the patient may only suffer with monthly pains for 
a day or two, accompanied with some nausea or vomiting and 
epistaxis. A sense of fullness and bearing down in the pelvis 
is felt; and from month to month the epigastrium enlarges. 
Often the poor, innocent patient is suspected of pregnancy, 
on account of the increase in the size of the abdomen, and 
the tendency to nausea experienced. When the atresia is 
in the lower portion of the vagina, the pressure of the h^em- 
atometric tumor may press so hard against the urethra as to 
cause retention of the urine, and upon the colon so as to 
cause obstinate constipation. Sometimes, when the atresia 
is not quite complete, there is an oozing of the serous por- 
tion of the retained blood at irregular intervals. Such a 
fistulous opening may for a time do much to prevent the 
severity of the symptoms caused from the retention of the 
flow, and will tend in a great measure to retard the develop- 
ment of the hsematometra. 

Prognosis. 

The prognosis is, as a rule, unfavorable if the case is left 
to itself; still, there are exceptional cases on record where 
the patient has maintained good health, although the uterus 
was distended with retained menstrual blood. Simon* relates 
such a case. Usually, however, with an operation, if prop- 
erly performed, the prognosis is favorable, especially if free 
evacuation of the vagina and uterus be accomplished. These 
cases are most likely to die from neglect, on account of an 
incorrect diagnosis, mistaking the hsematometra for dropsy, 
ovarian or uterine tumors. 

*Mon. f.. Geburtskunde, 1851. 



ATRESIA OF THE VAGINA. 507 

Treatment. 

Atresia being an organic obstruction, the treatment re 
quired is mechanical or surgical, though remedies are valuable 
in the treatment of the conditions of the general system 
dependent upon the retention of the effused blood and its 
reabsorption into the circulation. These remedies must be 
selected in accordance with the symptoms in each case on 
the general plan of homoeopathic therapeutics. But for the 
relief of the atresia an operation is required. Surgeons 
formerly fell into the error of making small incisions, and 
making two or three operations to complete the breaking up 
of the adhesions, and evacuating the hoematometra, which 
allowed of the introduction of air, and the decomposition of 
the retained blood. At present surgeons are unanimous in 
the opinion that the operation should be completed at one 
time, and the retained blood be freely evacuated, followed 
by a thorough cleansing of the uterus. 

Operation for Atresia or Absence of the Vagina. 

The patient is placed under the influence of Ether comp. 
while lying upon the back with the thighs flexed upon the 
abdomen. A lateral incision in now made in cases where 
there is no depression to indicate the location of the vagina. 
If there is a depression, make the incision vertical, and 
reaching from a point about one-half inch below the meatus 
to within an inch of the anus. We next introduce a steel 
sound into the urethra. (See Plate V.) It should be about 
eight inches in length, of large size, and bent at a right 
angle; about three inches from the expansion of the handle 
is the best, as it distends the urethra more, if large, and its 
bent form enables the assistant to hold it more out of the 
way. 

The assistant now seizes the handle of the sound and 
holds it firmly, as well as steadying the limbs, when the 



508 EATON ON DISEASES OF WOMEN. 

operator passes one finger of the left hand into the rectum, 
and with the index finger of the right hand attempts to 
force a passage between the rectum and the bladder, bear- 
ing in mind the natural backward curve of the vagina. If 
unable to force the finger through the tissues, the handle of 
a scalpel may be passed by the side of the finger, and its 
movement from side to side may greatly aid in breaking 
through the tissues. When bands of tough fibre are met, the 
blunt-pointed bistoury may be introduced to divide them, al- 
ways making the incisions laterally and keeping close to 
the rectum, so as to avoid wounding the bladder. When we 
arrive at the sac of the haematometra we may puncture it 
with the long curved trocar (see page 125), or Simpson's 
Hysterotome. (See Plate Y). After the puncture is made 
and the fluid somewhat drained away, the opening should 
be enlarged laterally, so that at least two fingers may be 
introduced. 

The uterine sound should be iioav inserted gently to 
ascertain if the cervix is pervious, and to note the size and 
position of the uterus and make sure that no blood is re- 
tained there. Usually in these cases we find the os uteri 
dilated by the retained blood, and we pass the finger readily 
into it Sometimes the distension is so great as to make the 
os three or four inches in diameter. 

We next introduce the tube of a Davidson's fountain 
syringe into the newly made vagina, or even into the uterus 
itself (using the vaginal tube), and thoroughly wash out the 
interior with carbolized warm water, placing a bed-pan under 
the patient, if it has not already been done. 

After the washing out is completed, we smear the parts 
through which we have torn or cut with Vaseline or carbolized 
ointment, and introduce into the vagina one of Sims' vaginal 
glass dilators of good size, smeared with Vaseline (see Plate 
No. VI). This is retained with a T bandage, directing that 
the nurse hold it in position with the fingers in case the 



ATRESIA OF THE CERVIX UTERI. 509 

bandage has to be removed for the calls of nature. Every 
twelve hours the dilator should be removed, the vagina 
washed with carbolized warm water and the dilator replaced, 
till the parts are thoroughly healed. 

After the operation is completed and the dilator inserted, 
the patient should be placed in bed in a room of a temper- 
ature at 70°, and suitably wrapped io maintain the heat of 
the body. The recumbent position should be maintained for 
about two weeks. The character of the fluid in the hsema- 
tometra merits a word. It is usually of dark color and rarely 
coagulated, owing to the deficiency of fibrine. The quantity 
varies in different cases, according to the length of time it 
has been accumulating. Leatherby analyzed forty oz., which 
gave water 875.4, albumen 69.4, globulin 49.1, hsematosin 
2.9, salts 8.0, fat 5.3, extractive 6.7. 

Occasionally this fluid undergoes decomposition, and ulcer- 
ation is established, ventilating the abscess into some of the 
adjacent cavities. Each case of this kind must be treated 
upon its merits. Generally speaking it is best to proceed 
with the establishment of the normal opening, if the patient 
is not in a condition of too great depression, for it is probable 
that with the establishment of the normal canal the fistulous 
opening would close by the natural restorative powers of the 
system. It has formerly been recommended to evacuate the 
hsematometra with a trocar through the rectum, an operation 
which is open to serious objections, and one entailing more 
danger than the establishment of the normal vagina, and it is 
now discarded. 

Treatment of Atresia of tlie Cervix Uteri. 

After opening up the vagina, we may find the cervix im- 
pervious; or it may be closed in cases where the vagina is 
of normal size The adhesions in the cervix may sometimes 
be divided by pressing into it the ordinary uterine sound. 
In other cases, it is necessary to use some instrument 



510 EATON ON DISEASES OF WOMEN. 

more pointed. Some recommend the piercing the cervix 
with a long slender-bladed, sharp-pointed bistoury ; but I 
prefer the long uterine trocar. (See Fig. No. 49.) First, 
we should take care to ascertain that there is no version 
or flexion of the organ, as well as we may do by digital 
rectal and vaginal, as well as conjoined, examination. This 
is usually not very difficult, as the distension of the uterus 




Fig. No. 49— Uterine Trocar. 



makes the examination more easy. The distension also, in 
most cases, produces a considerable shortening of the length 
of the cervix, especially if the atresia be confined to its lower 
portion. After introducing the trocar (which can usually be 
well done without anaesthesia.), it is well to wash out the 
cavity of the uterus with warm, carbolized water through the 
canula, after the contained fluid is drained off; and to pre- 
serve the opening, a carbolized sponge tent may be inserted, 
to dilate it for six or eight hours, after which, I introduce a 
good sized bougie, anointed with Vaseline, once a day, till the 
cervix is thoroughly healed. 

Bandaging — After operating on any case of atresia of the 
vagina or uterus, where there has been a large hsematometra 
formed, it is best to apply a large full compress over the epi- 
gastrium, and maintain it with a firm abdominal bandage. 



FISTULA?. 511 



CHAPTER XLVI. 

FISTULA 7 . 

VESIU0- VAGINAL FISTULA — RECTOVAGINAL FISTULA — RECTO-VESICAL FIS- 
TULA — VESICOCERVICAL FISTULA — URETHRO-V AGINAL FISTULA — IN- 
TESTLNO-VAGINAL FISTULA — URETO-V AGINAL FISTULA — VESICOUTER- 
INE FISTULA — PEEITONEO -VAGINAL FISTULA — PERINEO - VAGINAL 
FISTULA — BLIND VAGINAL FISTULA— FISTULA IN ANO. 

To save space and time, as well as to make clear these 
various fistulse and their appropriate treatment, I will discuss 
them in connection with each other. 

Fistula in ano is not peculiar to women, but results from 
an abscess in the cellular tissue surrounding the rectum, and 
is sometimes a result of cellulitis in the female as well as in 
the male. Fistula in ano may be complete or incomplete, 
internal or external. In complete fistula in ano there is a 
fistulous opening from the bowel to the external part of the 
perineum, or posterior to, or beside, the anus. In incom- 
plete fistula in ano the opening may only be external, in 
which case it is termed external fistula in ano; and when 
it opens into the rectum, and has no external opening, it is 
called internal, or blind, fistula in ano. When opening an 
abscess into the vagina, it is termed blind vaginal fistula. 

Vesico-vaginnl fistula signifies an opening between the 
bladder and vagina, allowing the urine to pass into the 
vagina. 

Vesico-urethral fistula signifies an opening between the 
urethra and the vagina, allowing the urine to pass into the 
vagina, as in vesicovaginal fistula. 

Vesicocervical, or vesico-uterine, fistula indicates a fistulous 



512 EATON ON DISEASES OF WOMEN. 

opening between the bladder and cervix uteri, allowing the 
urine to flow through the cervical canal and vagina. 

Recto-vaginal fistula signifies a fistulous communication 
between the vagina and rectum. 

Ureto vaginal fistula is one where the ureter opens into 
the vagina, either as a congenital deformity or as a result of 
laceration or ulceration of vesicor vaginal tissues. 

Intestino-vaginal fistula consists of a fistula between the 
small intestines and vagina, and may be applied to a recto- 
vaginal fistula also. 

Eecto-vesical fistula consists of a communication between 
the bladder and rectum, through an occluded or atresied 
vagina. 

Vesico-vaginal fistula is the most common form of vaginal 
fistula. 

Recto-vesical fistula is but little known. Simpson relates 
two cases. Most authors are silent upon this subject. It is 
usually, if not always, caused from an abscess in the upper 
part of the vagina, when there is complete closure of the 
lower part, and the abscess opens into both the rectum and 
bladder, allowing of the escape of the urine through the 
opening in the bladder into the vagina (which is occluded), 
and which has become in this case the cavity of the sac, 
and thence through the rectal opening of the abscess into 
the rectum. Fecal matter may pass into the bladder through 
this form of fistula. 

Ktiologry of Kistulae of tlie Vagina, Intestines, Bladder, and 

Rectum. 

Protracted labor is the most frequent cause of fistulse in 
the vagina, although they sometimes occur as a sequence of 
labors which are not of so very long duration as to be con- 
sidered tedious or protracted ; in these latter cases being 
caused by want of attention to the proper evacuation of the 
bladder during the progress of the labor, or to the presence 



VAGINAL FISTULA. 513 

in the bladder of a calculus, which gets lodged between the 
head of the child and the pubis. The use of Ergot is to be 
blamed for many cases of vaginal fistula, especially when 
administered to the patient before the os uteri is largely 
dilated, and before the head of the child has engaged in the 
superior strait. This agent produces such continuous con- 
traction of the uterus that unless the conditions of the os uteri 
and vagina are such as to allow of rapid delivery various 
injuries are liable to result, the most prominent of which are 
vesico-vaginal fistula and lacerations of the os uteri and 
perineum. It may be caused from a pessary cutting its way 
through, or from its long continued pressure causing an ulcer, 
and finally a fistula. 

• Recto-vaginal fistula is more seldom produced than vesico- 
vaginal, it being found in less than six per cent of the total 
number of cases of vaginal fistulse on record. The presence 
of internal piles serves as a cause of the recto-vaginal fistula. 
It may also be caused by instruments used in operating for 
atresia of the vagina. Recto-, vesico-, or urethro-vaginal, fist- 
ulse may result from accident in the attempt to establish a 
normal vagina in cases of atresia, or where it is congenitally 
absent. 

The use of the obstetrical forceps has been blamed for 
producing vaginal fistulse more than any other cause. It is 
true, a vaginal fistula has followed sometimes after instru- 
mental delivery with forceps, even when they have been 
used by skillful and experienced hands ; but still it is not 
clear to my mind that the instruments were the cause of 
the fistula. 

I am of the opinion that the long continued pressure 
of the head of the child upon the bladder and urethra, 
for a great length of time, causes the sloughing ?ind the 
resulting fistuln. My own opinion is (and I know the 
same opinion is entertained by many eminent obstetricians), 
that if the forceps were used more frequently, and without 

33 



514 EATON ON DISEASES OF WOMEN. 

waiting for forty-eight or sixty hours to elapse before 
using them after their necessity was evident, the cases 
of vesicovaginal, or urethrovaginal, fistulse would become 
exceedingly infrequent. I might mention several excellent 
reasons for their early use, but the discussion of the advan- 
tages of the use of obstetrical forceps does not come under 
the department of medical literature upon which I am now 
engaged. I desire simply to record here my belief in the 
fact that obstetrical forceps have been too much blamed for 
the causation of vaginal fistulse. In corroboration of this I 
will say that during the past ten or fifteen years vesicovag- 
inal fistuloe are becoming less and less frequent; and the use 
of obstetrical forceps has very largely increased in that time. 

Vesico- vaginal fistula is sometimes established artificially 
by the surgeon for the relief of chronic cystitis, as men- 
tioned under the head of cystitis. Dr. Emmet reports six- 
teen cases of this kind. 

Accidental incised wounds or lacerations from the break- 
ing of a glass syringe in the vagina may cause either vesico-, 
urethro-. or recto-vaginal fistula, and vesico- or urethro-vao;- 
inal fistuke ; or they may be caused accidentally, in opera- 
tions for the removal of a stone from the bladder. A pelvic 
abscess may ulcerate through, so as to cause either a vesico-, 
blind-, or recto-vaginal fistula. 

Vesicovaginal fistula has been known to result from a 
calculus in the bladder upon which no operation had been 
attempted, and which had no connection with labor. Schroe- 
der* mentions a case, reported by Simon, in a girl eight 
years old. Intestino-vaginal fistula may result from lacera- 
tion of the cervix in labor, extending to and including the 
posterior vaginal wall in its upper part, allowing the pro- 
trusion into the vagina of a knuckle of intestine through the 
rent, this being followed by inflammation, strangulation, gan- 
grene; and sloughing, a fistulous opening or an anus prceter- 

* Ziemssen's Cyclopaedia, Vol. X, page 515. 



VAGINAL FISTULA 515 

naturalis is established. Falls upon sharp sticks, penetrating 
the vagina, syphilitic or cancerous ulceration may cause 
either of these fistulse of the vagina. Ulcerative action in 
the bladder, or syphilitic, or diphtheritic ulceration in the 
vagina may also cause them. 

Vesicocervical or vesico-uterine fistula may be caused 
from laceration of the cervix in confinement, implicating the 
vesical wall. The vagina and lower part of the cervix heal 
and the vesicocervical fistula remains. This is sometimes 
carelessly termed vesico-uterine fistula. 

Diagnosis. 

Generally the first symptom which is noticed in vesico or 
ure thro- vaginal or vesicocervical fistula is a dribbling of 
urine from the vagina. This the patient at first supposes is 
the result of inability to hold it on account of weakness of 
the parts. Soon she finds that upon attempting to pass her 
urine little or none passes through the natural outlet, but 
passes through the vagina, and she takes alarm and con- 
sults her physician. The diagnosis of the exact nature 
of the difficulty is made out by a conjoined exploration 
with a finger of the left hand in the vagina, and with 
the sound in the urethra or bladder. Sometimes the fist- 
ula is so small as to make it impossible to pass the sound 
through it, and it then becomes necessary to examine the 
vagina with a Sims' improved speculum (as invented by Daw- 
son), or a trivalve, thus bringing the anterior wall of the 
vagina into view, as well as the os uteri. If the urine be 
found dribbling from the os uteri, this fact is conclusive of its 
beinof a case of vesicocervical fistula. 

Recto-vaginal fistula is discovered by the passage of 
flatus and fecal matter per vaginam. The examination 
made with a finger in the rectum, and a sound or probe intro- 
duced through the vaginal opening of the fistula, till it pene- 
trates the bowel through the rectal opening, is necessary to 



516 EATON ON DISEASES OE WOMEN. 

determine its exact locality and size. Either of these fistulse 
may be large enough to admit of the passage of a finger 
through them, but this is not often the case. 

Intes tin o- vaginal fistula is diagnosed by finding the rectum 
intact, and discovering the fistula in the upper and posterior 
part of the vagina, conjoined with the character of the dis- 
charges, which are thin and bright yellow mingled with par- 
ticles of food or fecal matter. 

Treatment. 

Recent Cases. — In the treatment of recent cases of vesico- 
or u re thro- vaginal or vesicocervical fistula the patient should 
lie uninterruptedly upon the side (if the laceration or fistula, 
is situated to either side of the median line in cases of 
vesico-vaginal fistulse the patient should lie upon the opposite 
side), that the urine may be retained in the bladder for some 
time without passing through the fistula. 

A silver self-retaining catheter should be placed in the 
bladder by passing it through the urethra (a small size should 
be used if the fistula communicates with the urethra so as 
to not stretch the canal in the least). The catheter should 
be removed and cleansed every two or three days to prevent 
incrustations of phosphatic deposits on the surface. Making 
sure that the urine in the bladder is all discharged, we may 
daily turn the patient from side to side, and use a warm vag- 
inal injection of water and castile soap. 

Attention should be given to the diet and various hygienic 
means to place our patient in as good a general condition of 
health as possible, and such remedies given as seem to be 
homoeopathically indicated. By following out this plan 
very many cases will spontaneously recover in periods of 
time varying from two to six weeks. 

I am pleased to see that Professor Emmet* encourages 
conservative treatment in these cases. He says: "In arti- 

* Emmet's Prin. and Prac. of Gynaecology, page 618. 



VAGINAL FISTULA. 517 

ficial fistulse the raw edges are kept in a healthy condition 
by the frequent use of the injections (warm water) and free 
from the irritation always exerted by a deposit from the 
urine. Whenever this is done the largest sized artificial 
opening will often rapidly close of itself." He relates two 
cases which were sent to the hospital immediately after 
delivery, who were suffering from fistulse of the vesico- vag- 
inal variety, of a size large enough to admit of the introduc- 
tion of the index finger into them, which healed rapidly 
under the treatment of warm vaginal injections. 

If there is present any inflammation of the bladder or 
abnormal condition of the urine, we may introduce the warm 
water directly into the bladder through the catheter, or by 
way of the vagina through the fistulous opening. In cases 
of several months or of years' standing, an operation is 
usually necessary to cause union of the edges of the fistuloe. 
Sometimes, however, they may be cured by remedies and 
local applications to stimulate granulations. 

We must be guided much by the circumstances of the 
case and the wish of the patient and friends in the treat- 
ment. We can usually promise a good hope of a cure from 
an operation, but some patients have a serious objection to 
an operation who are willing to suffer a great amount of incon- 
venience and great loss of time, and be put to any amount 
of expense in order to avoid an operation. In this class of 
cases it is advisable to make an attempt to cure the case 
by other means. These measures must have for their end the 
cleansing of the vagina and the fistula from all phosphatic or 
other deposits, causing the urine to flow through the normal 
canal and causing granulations to develop around the fistula, 
so as to approximate its edges, and, finally, to cause union, 
thereby obliterating the fistula by this process. It is really 
aiding nature to pursue the same process which it under- 
takes so successfully in the recent case, as I have learned 
from experience it will do, and as I have quoted from Dr. 



518 EATON ON DISEASES OF WOMEN. 

Emmet to show that it has been seen in the experience of 
others. 

First, then, if we are to make the attempt to heal the 
fistula without operation, we must attend to the cleansing 
and healing of the vagina, for in some cases the parts be- 
come exceedingly inflamed, and in some instances ulcerated. 
In some patients, where the urine is very heavily loaded with 
the phosphates, even the thighs on the inside and the but- 
tocks become inflamed and ulcerated, and it is best to relieve 
these parts of the inflammation and heal the ulceration be- 
fore proceeding to apply treatment to the fistula, otherwise 
the pain which we would cause in attempts to get at the 
fistula would be almost unendurable. For this purpose the 
flow of urine through the fistula must be arrested. This is 
to be accomplished by placing the patient upon her side and 
introducing into and leaving in the urethra a suitable cathe- 
ter (some prefer silver, some gum elastic), and retaining it 
there and cleansing it often, as in the recent case, and ad- 
ministering to the patient remedies calculated to restore the 
urine to a normal condition. 

Remedies. 

The following remedies should be studied in the Materia 
Medica, and prescribed according to the totality of the symp- 
toms : 

Sepia, China, Dig., Puis., Cal. carb., Nit. ac., Sulph., Spon- 
gia, Phos., Phos. ac., Ferrwn, Terebinth., Ant. cru., Merc., Sol., 
Ars. iodid. Acidulated drinks may be freely used, that, if 
possible, the urine be kept in a normally acid condition. 
The incrustations must be washed or wiped away, using a 
very soft cloth or sponge saturated with warm water, to 
which a very little castile soap is added. After washing 
away the incrustations, the parts inflamed or ulcerated 
should be bathed with Calendula wash, made by adding 
about four ounces of water to a table-spoonful of Tr. Calen- 



VAGIXAL FISTULA. 519 

dula. This should be repeated four or five times a day till 
the parts are healed. It is well to use Vaseline over the 
parts when almost healed, to soften them and prevent the 
formation of a cicatrix around the point ulcerated. 

After the vagina has been healed so that nothing remains 
abnormal but the fistula, we introduce into the vagina a 
Dawson's improved Sims' speculum, so as to bring the vag- 
inal portion of the fistula into view; then with a syringe 
which has a long, curved nozzle inject the bladder through 
the fistula (if it be vesico-vaginal) with warm soap and water 
daily. After the free use of the water we pass a sound wrap- 
ped with cotton saturated with Iodine through the fistula, 
15 grs. to the oz., taking pains to apply the Iodine to the 
margin of the fistula thoroughly, but not so freely as to al- 
low it to drop into the bladder or vagina. 

If the fistula is vesico-cervical, we pass the Iodine up into 
the cervix to the point of the opening of the fistula, and hold 
it there for a few moments, turning the patient a little on to 
her face, so as to aid the Iodine in passing into the fistula. 
In case the os uteri is not large, dilate it with sponge tents, 
so that the sound wrapped with cotton may pass without 
being compressed, so as to drain off the Iodine before it reaches 
the fistula. 

In case the fistula is urethro-vaginal, the edges of the 
fistula may be touched with a brush saturated with the Iodine, 
after thoroughly cleansing the parts with the warm water and 
soap, by means of a soft sponge. The strength of the Iodine 
must be increased if we find after two or three weeks that 
no granular inflammation is established in the walls of the 
fistula. After granulations have become well established (and 
the fistula is a large one) we gain much time by taking two or 
three stitches with silver wire, to draw the edges of the fistula 
together. The patient will sometimes be willing to submit to 
our placing two or three sutures, after she has been treated 
some time, who would not submit to an operation at first. 



520 EATON ON DISEASES OE WOMEN. 



Operation for Vesicovaginal Fistula. 

In the very recent case of vesico-vaginal fistula, if the 
patient be willing to submit to an operation, the sooner it is 
performed the better, if the patient's strength is sufficient to 
allow of it. The bowels should first be freely evacuated by 
enemse of warm water. No anaesthetic is usually required, in 
the recent case, a good drink of Sp. Vin. Fermenti being suffi- 
cient to brace the nerves for the operation. The patient 
should be clothed in flannel drawers and under vest, with a 
night dress over, which should be drawn up around the waist. 
She should lie upon her left side with the thighs flexed upon 
the abdomen. She should lie upon a high operating chair or 
table, high enough so that the operator may sit conveniently. 
(It is next to impossible to perforin the operation satisfac- 
torily with the patient upon an ordinary bed or lounge.) A 
Sims' speculum should be introduced and held in position by 
an assistant, so as to bring the fistula into view. If the 
speculum does not readily bring the fistula into view, a re- 
tractor must be introduced to draw back the perineum and 
posterior part of the vagina. 

We now proceed to inspect the parts, and determine what 
plan to pursue. If the edges of the fistula appear healthy, 
and appear to have vitality enough to promise a prospect of 




Fig. No. 50. — Sims' Needle Holder. 

adhesion taking place when they are placed in apposition, we 
may proceed at once to stitch them together, placing the 
sutures (which should be of silver wire) in the position which 



VAGINAL FISTULA?. 521 

will most conveniently draw the edges together. The stitches 
should be placed about three-eighths of an inch apart, and 
may or may not be set deeply enough to include the vesical 
mucous membrane. I prefer to include this membrane in 
placing the suture, using the semi-circular vesico-vaginal 




Fig. No. 51. — Emmet's Counter-Pressure Hook. 

needle; and have the wire threaded, into the needle, at least 
eighteen inches long. Seize the needle near the eye with 
a long-handled pair of straight, slender needle forceps, if the 
longest diameter of our incision corresponds with the median 
line; but if the longest diameter of the incision is transverse 
the vagina, we use our curved needle holder. (See chapter on 
Instruments; also Plate VI.) This enables us to grasp the 
needle so as to insert it in a direction corresponding to the 
median line very conveniently. 

By using my needle holder we see clearly what we are 
doing, as the handle of the holder is to one side of the vagina 
while we insert the needle. This needle holder is curved 
simply in the blades which grasp the needle, holding it at 
right angles, with the handle of the holder, and with its con- 
cavity directed towards the operator as he holds the needle 
in the grasp of the holder ready for use. Pierce the tissues 
on the upper side, about one-fourth of an inch back from the 
fistula, press it through till about one-half the needle emerges 
from the fistula ; then let go the end of the needle, and seize 
it in the portion emerging from the fistula, as far back towards 
the eye as we can, and draw it through, and then insert the 
needle in the opposite side by entering the needle into the 
fistula, and bringing it out one-fourth of an inch to the side of 
the fistula, opposite the one we at first pierced. Now seize 
the needle with the forceps and draw it through till it is out- 
side the body, pressing back the tissues with the counter- 



522 EATON ON DISEASES OF WOMEN. 

pressure hook, or Nott's Depressor (see Figs. 51, 52); tak- 
ing care to hold on to the end of the wire, that it be not 
drawn entirely through. 

Now we have the stitch inserted and both ends of the 
wire within our grasp. Pass both ends of the wire through 
the eyes of an instrument I have invented, called a wire holder 
and twister. (See chapter on Instruments, and Plate VI.) 
Holding on to the ends of the wire passed through the eyes 



G. r/FMAA/A/. CO. 




Fig. No. 52. — Nott's Depressor. 

of the instrument with one hand, we carry the wire holder 
down to the fistula with the other, steadying it there by the 
handle. We now seize the ends of the w r ire and the handle 
of the holder and twister, pressing the holder down firmly 
upon the vaginal tissue, and drawing the w T ire a little tightly 
we approximate the edges of the fistula by this movement; 
and we have but to turn the instrument round in our fingers 
three or four times, and the wire is firmly twisted. , 

Now remove the holder and cut off the wire with a long 
pair of scissors about a half-inch from the vaginal tissues. 
Other sutures are to be placed in the same manner till the 
fistula is closed. 

The stitches should be allowed to remain for about ten 
days or longer, and every day we may make an application to 
the edge of the fistula of Tr. of Iodine to excite adhesive in- 
flammation, using a Sims' speculum gently, to bring the parts 
into view. The vagina and bladder should be daily injected 
with Calendula wash, and the patient should be kept upon 
her side with a catheter retained within the bladder, passed 
through the urethra, removing and cleansing it, however, 
every two days, to prevent incrustation upon its surface of 
phosphatic deposits. If pain is complained of, Arnica or 
Cantharides are usually indicated. If inflammation arise with 



VAGINAL FISTULA. 523 . 

fever, Aconite is the indicated remedy at first, usually fol- 
lowed by Bryonia. Generally these four remedies are the ones 
required, unless complications arise, which must, of course, 
be treated according to the most prominent indications. 

Operations in Chronic Cases of Vesico-vaginal Fistula. 

Chronic cases have to be treated somewhat differently 
from the recent case. In chronic cases the fistula has be- 
come incrustecl with urinary deposits, and a sort of mucous 
membrane has formed around the fistula. This must be cut 
away, and a raw, fresh surface made before the sutures are 
inserted, in order to secure union by first intention, or even 
rapid union by granulation. For this purpose the long-handled, 
curved-bladed scissors are the most convenient. After the 
preparatory treatment previously mentioned in operations on 
the recent case, and having cleared the parts from incrusta- 
tions and applied Calendula tvash till the vagina is in a 
healthy condition, the patient having been for some time 
kept on her side with a catheter in the urethra to secure 
the free drainage of the urine from the bladder, that it may 
not pass through the fistula and keep up the irritation. Due 




Fig. No. 53. — Bozemax's Curved Scissors. 

attention should be given to the general health of the pa- 
tient, that there may be as much plasticity of the blood as 
possible; the bowels kept open by injections of water and 
indicated homoeopathic remedies. 

The operator should have four reliable, intelligent assist- 
ants, and see to it that warm and cold water in suitable ves- 
sels is at hand, with towels, napkins, rags, sponges, hema- 
statics, needles, and other instruments he may require, not 



524 



EATON ON DISEASES OF WOMEN. 



forgetting Spts. Ammonia and Nit. Amyle (for the prompt use 
of these remedies may save a life, which otherwise might be 
lost by the administration of anaesthetics). 

Every thing being in readiness, the patient may be placed 
under an anaesthetic while in bed, and after anaesthesia is 
partially induced, the operating table and instruments may 
be brought in from an adjoining room, where they have pre- 
viously been prepared, together with the other conveniences 
already referred to. After anaesthesia is quite profound, the 
patient may be lifted upon the operating table, taking care 
to keep her head as low as her body, for otherwise death 
might make further steps in the operation quite unnecessary. 
The patient is to be placed upon her left side, with her 
head low, and an experienced physician given charge of the 

keeping of the patient under 
the effect of the anaesthetic 
properly. The Sims' specu- 
lum and retractor is to be 
used as before mentioned. 
The right limb should be 
supported upon a large pillow 
to separate the limbs. We 
now seize one edge of the 
fistula with the tenaculum, 
raise it slightly, insert the 
scissors or slender scalpel, 
and freshen the margins of 
the fistula, making the open- 
ing in the vagina somewhat 
elliptical, or diamond-shaped, 
as represented by the dotted line in Fig. No. 54. This 
enables us to adjust the edges more evenly than we could by 
leaving the margin of the fistula round or irregular in shape. 
In freshening this surface with the scissors, it is best to ex- 
ercise a little care to not include the cystic tissue, for great 




Fig. No. 54. 



VAGINAL FISTULA. 525 

hemorrhage would be likely to ensue, and defeat, for a time 
at least, the success of the operation. 'T is true, Simon in- 
cluded the vesical mucous membrane in his incisions ; but 
how he could succeed in preventing troublesome and dan- 
gerous hemorrhage we can not see. Prof. Peaslee lost a 
case from this cause. Prof. Emmet came near losing two 
patients in this manner. 

If we should accidentally incise the bladder in making 
these incisions to freshen the edges of the fistula, Ave should 
saturate a handkerchief in a small part of its central portion 
with liquid Ferri Persulpk., and insert it by means of the 
finger or a sound through the fistula into the bladder, and 
then pack cotton into its interior till strong pressure is ex- 
erted against the walls of the fistula, especially the incised 
portion. 

When, however, we have succeeded in freshening the 
vaginal tissues without cutting the cystic membrane and 
causing excessive hemorrhage, we may, as soon as the little 
hemorrhage commonly present is arrested with cold applica- 
tions, proceed to insert the sutures, as described in the treat- 
ment of the recent case; and the after treatment is about 
the same, save that there is no need in these cases of ap- 
plying any Iodine to the seat of the fistula, for the freshen- 
ing of its edges has placed it in a condition to heal by what 
is termed first intention, while in those cases called recent, 
the union is usually produced by the throwing out of granu- 
lation, the cases being of several days' standing. 

After the operation is completed, Avash all blood out of 
the bladder Avith the reversible catheter and a syringe. 
Now, the patient should be placed upon her side in bed, 
and alloAved to come out from under the influence of the 
anaesthetic. The catheter should be retained, as previously 
mentioned, and the patient kept upon the side for at least 
ten days or two Aveeks. The Calendula tvash may gently be 
injected into the vagina and bladder each day, and the bowels 



526 



EATON ON DISEASES OF WOMEN. 



may be moved by warm water enemae. Aconite, Arnica. 
Hamamelis, Canthar., or China may be indicated. 



Operation for Uretnro-vaginal Fistula. 

The same general principle of treatment holds good in the 
treatment of ure thro-vaginal fistula, as I have just described 
in the treatment of vesico-vaginal fistula. The laceration is 
usually at the upper portion of the urethra, and extends 
somewhat into the bladder, the peculiarity of this condition 
being the amount of protrusion of vesical tissue which pro- 
lapses through the fistula into the vagina, making it neces- 
sary to modify the steps of the operation somewhat from that 
just described in the treatment of vesico-vaginal fistula. 
Fortunately the parts are more easily reached than where the 

fistula is situated higher up in the 
vagina, and consequently the pro- 
lapsed tissue can be more readily 
replaced than it could be if it oc- 
curred in vesico-vaginal fistula. 

The patient should be prepared 
for the operation the same as in 
vesico-vaginal fistula. The prepa- 
ration of the clothing, table, and in- 
struments about the same. A good 
sized sound should be introduced 
into the bladder through the urethra 
and held by an assistant; or a ca- 
theter may be used in place of the 
sound, which saves the necessity 
for the removal of the sound and 
the introduction of the catheter after 
the completion of the operation, 
which is certainly some advantage. If the case is a recent 
one, and the vaginal edge of the fistula has granulating sur- 
faces, we at once proceed to stitch them together with the 




Fig, No. 55. 



VAGINAL FISTULjE. 



527 



silver wire, using the semi-circular vesico-vaginal needle to 
carry it. Care must be taken in placing the sutures, that 
we turn back into the urethra the redundancy of tissue which 
protrudes through the fistula ; for, 
should we cut it away, we would 
deprive the patient of retentive 
power in the bladder, as it is this 
redundancy of tissue, which serves 
in place of a true sphincter muscle 
at the neck of the bladder; and be- 
sides the cutting away of this ap- 
parent excess of tissue would very 
likely cause alarming hemorrhage. 

There is, perhaps, more skill re- 
quired in the placing of the sutures 
in urethrovaginal fistula than in 
cases of vesico-vaginal fistula. The 
needle must be inserted, so that 
when the suture is tightened the 
protruding tissues are turned back 
into the urethra, and the vaginal 
membrane is brought together over them. Either the straight 
or my curved needle holder may be used, as the rent is sit- 
uated longitudinally or transversely to the axis of the vag- 
ina — the straight holder being most convenient in inserting 
the needle from side to side (see Fig. No. 55), and my curved 
holder if we haA^e to insert it from above downwards, or 
vice versa. (See Fig. No. 56.) After the wire is inserted 
the ends of the wire are passed through the eyes of my wire 
holder and twister (Plate VI), and the wire tightened as 
we draw gently upon the ends of the wire, and carry the 
holder down firmly against the vaginal tissues, at the same 
time aiding the turning in of the prolapsed vesical tissue 
with the finger of the left hand while we hold the twister 
with our right, at the same time grasping the wires, together 




Fig. No. 56. 



528 EA TON ON DISEASES OF WOMEN. 

with the handle of the instrument. Twisting the wires once 
around the index finger of the right hand, enables us to 
make traction upon the wire, and press the instrument up 
against the fistula firmly, and gives us the use of the left to 
turn in the excess of tissue at the same time. After the 
raw vaginal surfaces of the opposite sides of the fistula are 
brought together the twister is to be turned around about 
three times to secure the suture, when the instrument is 
withdrawn and the wire cut as before. 

In case the ure thro- vaginal fistula is of several months or 
years standing it becomes necessary to freshen the edges of 
the fistula before taking the sutures. In this part of the 
operation care is to be exercised not to sut the prolapsed 
cystic tissue. A small tenaculum is convenient to lift up the 
vaginal tissue around the fistula, so that we can incise it with 
a, pair of scissors. (The long, slightly curved scissors, page 
523, are the most convenient.) After freshening the vaginal 
edge of the fistula the superabundant prolapsed tissue is to be 
rolled back into the urethra, and the sutures placed as just 
mentioned in the treatment of the recent case. After the 
operation the patient is to be treated in all respects as after 
the operation for vesico-vaginal fistula. 

Treatment of Recto-vaginal Kistulae. 

There are sometimes serious obstacles in the way of the 
treatment of recto-vaginal fistulse. When the recto-vaginal 
fistula is caused from syphilitic ulceration no operative pro- 
cedure can be of any use, on account of the want of plas- 
ticity in the tissues. In this instance remedies given inter- 
nally for the syphilitic condition of the blood, together with 
local applications of Calendula wash to the vaginal membrane 
to heal it, and of Tr. of Iodine directly into the fistula to 
stimulate granulations around its margin, is the advisable 
treatment. 

In cases of cancerous ulceration, causing the recto-vag- 



VAGINAL FISTUL/E. 529 

inal fistula no operation is advised. The application of 
Kreosote l x locally, with the internal use of Phytolac. dec, 
Thuja, Merc, cor., Nit. ac, etc., is most commonly the indi- 
cated treatment. We may say, incidentally, that this plan 
of treatment is applicable to either form of vaginal fistula 
caused from syphilitic or cancerous ulceration. 

Where the recto-vaginal fistula is the result of direct 
injury (called traumatic lesion) we should at once cleanse 
the parts thoroughly, and evacuate the bowels freely with 
enemse. Give remedies to cause a cessation of peristalic action 
in the bowels, and prevent their moving for a week or so, 
keeping the patient nourished with beef tea, and maintaining 
the horizontal position in bed, that every thing may be favor- 
able to the healing of the wound by first intention. If in 
three or four days we make a careful examination of the 
parts, and find they have not healed, stimulating local appli- 
cations may be made to the lacerated surfaces to aid in pro- 
moting adhesive inflammation or granulation ; and the bowels 
should be still longer kept inactive, and the diet of beef tea 
continued for perhaps two weeks more. If by this time Ave 
find we have failed in securing union of the edges of the 
wound we had better allow the bow r els to move, and restrain 
them again for two weeks, especially if we find the appear- 
ance of the fistula indicates that by that time it may become 
closed. During this time the daily use of warm water vag- 
inal injections is of great service. 

It is adA r isable to stitch the lacerated tissues together in 
some instances where they are extensively divided. To do 
this the patient should lie upon the back, with the thighs 
flexed upon the abdomen. (See chapter on Lacerated Per- 
ineum.) The vagina is conveniently dilated with two of 
Dawson's improved Sims' speculums, one on either side, 
screwing open the divided blade to give room to examine the 
laceration, and to take the stitches. The same instruments 
are required as in operating for vesico-vaginal fistula, except 

34 




530 EATON ON DISEASES OF WOMEN. 

that no freshening of the edges of the fistula is required in 
the very recent case. Where the injury has been received 

several weeks or months 
previous to the time we 
are called to take charge 
of the case, or to operate, 
it is necessary to freshen 

Fig. No. 57.— Curved Scissors. , .. n 

the edges ol the fistula 
before stitching them together ; and here we may use the 
curved scissors. (See Fig. No. 57.) 

Cases of recto-vaginal fistula which have been caused 
from an abscess between the vagina and rectum may require 
a somewhat modified treatment if they are of long standing. 
The collapse of the sac of the abscess, and the adhesion of 
its walls in some instances, causes the vaginal walls to be- 
come so firmly adherent to the rectum and sides of the pelvis 
that it is necessary to loosen them from their attachments 
before the edges of the fistula can be brought together with- 
out using an undue amount of traction, which would be likely 
to cause the sutures to cut through before union had taken 
place. It then becomes necessary to separate or dissect up 
the vaginal tissue, so that it is capable of being drawn by 
the sutures enough to promote union of the edges of the 
fistula without causing the sutures to cut through the tissues. 

For this purpose we seize a portion of the vaginal mem- 
brane nearest the fistula with a tenaculum, or a pair of dress- 
ing forceps, after having freshened the edge of the fistula, 
and with a scalpel dissect up the membrane a short distance ; 
then insert the handle of the scalpel, or use the end of the 
finger, to further divide or peel up the membrane, sweeping 
the finger around the circle of the fistula till the vaginal 
membrane is quite free for a distance of an inch and a half 
or so on either side of the fistula, after which we may bring 
the edges together with interrupted suture. The vaginal 
membrane again unites to the rectum and sides of the pelvis, 



VAGINAL FISTULAL. 531 

but in a different position. It now forms a wall for the 
vagina, and partially for the rectum as well 3 and finally a 
true mucous membrane is formed over the new vaginal patch 
of membrane on its rectal side, curing the rectal opening in 
this way. When, however, the opening of the fistula in the 
rectum is directly opposite the one in the vagina we may at 
the first operation divide the recto-vaginal septum slightly, 
hook out the rectal membrane with a tenaculum, slightly 
freshen the edge of this membrane, place two or three sutures 
in it, and on the tenth day remove these sutures, and com- 
plete the operation by closing the vaginal opening of the 
fistula, as just described. 

Time to Operate. — About four or five days after the 
menstrual period is usually the best time to select for oper- 
ating upon either variety of vaginal fistulae, and should not 
be within ten days of the expected commencement of the 
menstrual period. The reason for this is obvious. 

Recto-vesical Fistula. 

This form of fistula in the female is very rare, as I have 
stated, and can not exist independently of atresia of the 
vagina. Keeping the patient on her side, with a catheter 
retained in the bladder for several weeks, may effect a cure 
of the cystic portion. It is well to restrain the action of 
the bowels at the same time. The menstrual flow might 
then take place through the rectum, if that part of the 
fistula, remained open. We may operate for the atresia first, 
and afterwards for the fistulas, which would then become 
vesico-vaginal and recto-vaginal, and may be treated in a 
similar manner as when present singly, as a result of severe 
labor. 

Vesicocervical, or Vesico-uterlxe, Fistula. 

It has been suggested to artificially cause occlusion of 
the vagina in this form of fistula, but the operation must 



532 EATON ON DISEASES OF WOMEN. 

always prove unsatisfactory, on account of the retention of 
stale urine in the superior portion of the vagina not occluded. 
Occluding the lower part of the cervix uteri is, to my mind, 
a much more desirable operation. To do this Ave draw out 
slightly a little bit of the cervical membrane, and clip it 
with scissors, having previously drawn down the uterus with 
a stout tenaculum to the os vaginam, which should be held 
there by an assistant holding the tenaculum upwards against 
the pubis. We may now seize the clipped piece of the 
lining of the cervix, and dissect it out all around; then 
insert a silver wire suture so as to draw the lips of the os 
uteri quite firmly together. Leave the suture seven or eight 
days. If atresia of the cervix results the menstrual flow 
may pass away through the bladder. Frequent evacuation 
of the urine must always be attended to, that it does not 
back up into the uterus. 

Treatment of Ureto-vaginal Vistula. 

If congenital this difficulty can not be cured. If acci- 
dental the ureter is attached to a piece of the vesical mem- 
brane; and the ureto-vaginal fistula may be treated similarly 
to the vesico-vaginal, of which it is a complication, if it 
exists at all. We must, however, be cautious not to include 
the ureter in our sutures. Taking care not to do this, we 
treat the case exactly as an ordinary vesico- or urethrovag- 
inal fistula. 

Treatment of Intestiiio-vagrinal Fistula. 

Very small fistulse of this variety may be treated by 
frequent applications of solid Argent, nit. If large the edges 
of the intestine should be freshened and stitched together. 
When union of the edges of the fistula has taken place. 
so far as the intestine is concerned, the vaginal rent may 
be freshened (after returning the prolapsed intestine) and 
stitched, as in recto- or vesico-vaginal fistulae. 



VAGINAL FISTULA. 533 



Treatment of Fistula in Alio. 

This difficulty, arising from an abscess caused by pelvic 
cellulitis^ is to be treated by remedies and means to cause irri- 
tation in the cavity of the abscess; and, consequently, closure 
of both abscess and fistula. Sometimes the injection of dilute 
Tr. Iodine comp. into the abscess, and repeated every two 
days-, conjoined with pressure against the perineum, cures 
these cases readily. Merc, CaL curb., Sepia, Niix, etc., are 
the usually indicated remedies. If all these means fail, free 
division of the tissues with the bistoury and applying some 
irritant to the fistula itself, is the means to be used in very 
obstinate cases of complete fistula in ano. In incomplete 
fistula the treatment is similar, except that sometimes it is 
necessary to make an incomplete internal into a complete 
fistula in ano, by making an external opening, so as to eva- 
cuate perfectly all the matter contained in the sac, which is 
often situated at the extremity of an internal blind fistula, and 
then to treat the case as in ordinary complete fistula in ano. 
Sometimes the insertion of a thread into or through the 
fistula, bringing it out through the anus and tying it, and then 
moving it from day to day, causes an irritation, which pro- 
motes the throwing out of granulations; and, consequently, 
causes a cure of the fistula. In works on surgery this fistula 
is usually w 7 ell described, and its treatment fully laid down. 
I will say, however, that I have cured many cases without a 
resort to incision, or the use of the seton or ligature, by means 
of the treatment first suggested. 

Results of Treatment of Vaginal Fistula. 

Taken altogether the result is* usually satisfactory; much 
is dependent upon the extent of the loss of tissue from 
sloughing, and the skill of the physician, as well as the willing- 
ness of the patient to co-operate in the treatment. Professor 



534 EATON ON DISEASES OF WOMEN. 

Emmet* has given us some valuable and interesting records 
of cases, which I take the liberty to abridge and record here. 
He reports but one death out of 171 cases of vesico-vaginal 
fistulse operated on. In 6 cases the result he reports un- 
known, improved 11, not improved 4, cured 149. These 
were, I understand, all chronic cases, except two, which re- 
covered without operation. Doubtless even this favorable 
result may be improved somewhat in a general average of ail 
cases which may hereafter be recorded, owing to a better un- 
derstanding of the difficulty by the profession at large. The 
operations for vesico-urethral fistula show about as good suc- 
cess, though the number recorded is much smaller. 

Other Methods of Operating In Vesico-vaginal and Urethro- 
vaginal Fistulse. 

Sims' Operation. — Professor Sims' operation, as described 
by Thomas,f is somewhat different. He prepares the parts for 
the sutures by freshening the edges in a similar manner, and 
then takes stitches with silk thread first, and then, after they 
are inserted, he attaches the silver wire to the end of each 
silk ligature, then draws the wire through the tissues with 
this, cuts off the silk from the wire, then twists the wires 
with his wire twister, which has a slit in it to hold the wires 
(a sort of fork in shape). We think the introduction of silk 
sutures, to draw the silver wire suture through with, is quite 
unnecessary and is liable to many embarrassments. 

First. As he inserts all the silk sutures before he attaches 
a wire there is confusion among the threads. 

Secondly. The silk suture may break when drawn upon 
firmly enough to draw through the loop of the wire. 

Thirdly. We sometimes find it impossible to make the 
wire come through the opening in the tissues made by the 
needle. 

* Emmet's Principles and Practice of Gynaecology. 
t Diseases of Women. 



Plate XVII. 




UTERUS DRAWN DOWN, TO BRING INTO VIEW A VESICO -VAGINAL FISTULA, 
FOR CONVENIENCE OF OPERATING. 



VAGINAL FJSTULAl. 535 

Fourthly. This plan leaves the fistula entirely open till 
all the sutures are placed, and we have trouble in selecting 
the right ends to twist together, or get the other wires twisted 
in with the suture we are attempting to secure. 

Simon's Operation. — He places the patient on her back, 
with, the hips at the edge of the table, and resting upon a 
large, hard pillow — uses wide specula, as retractors. He 
incises the vesical mucous membrane in freshening the edge 
of the fistula, as I have before mentioned. When possible to 
do so he draws down the uterus exterior to the body, thereby 
inverting the vagina and bringing the fistula into view, which 
simplifies the operation materially. (See Plate XVII.) He 
places two rows of sutures, one to approximate the edges of 
the fistula, and the other, inserted further back from the 
laceration, to take off any strain on the first sutures. He 
objects to the retention of the catheter in the bladder. 

Removal of Sutures. 

In about ten or twelve days the sutures may be removed. 
Some operators remove them sooner, even as early as five or 
six days ; but we prefer to wait ten or twelve days, so as to 
secure as firm a union as possible before they are removed. 
Sometimes there exists a small fistula on the sixth day which 




Fig. No. 58. — Cutler's Foeceps and Suture Cutter. 

will be healed by granulation by the twelfth day; and if we 
removed the sutures on the sixth day in such a case we would 
be likely to make the fistula larger by drawing out the wires, 



536 EATON ON DISEASES OF WOMEN. 

and cause a necessity for a second operation. To remove the 
sutures pass the index finger of the left hand into the vagina 
and feel for I he highest suture; then with Cutler's suture cut- 
ter and forceps we cut and remove it; then the next below, 
and so on. This instrument is the invention of Mr. W. P. 
Cutler, a student of mine, and is very convenient. It is 
made about seven inches in length, with a cutter placed on 
one side of the upper blade. The lower blade is made 
probe pointed to insert under the suture more readily. 

Method of Using the Instrument. — Insert the index 
finger of the left hand into the vagina till we feel the highest 
suture ; then insert the forceps with the right hand, keeping 
them closed, using the finger already introduced as a guide ; 
insert the point of the lower blade under the suture to the 
right of the twist, open the blades a little, so as to allow the 
wire to pass between them; then close the forceps which cuts 
the wire and grasps the twisted end and holds it firmly, when 
we gently lift the suture out of the tissues. The cutting and 
grasping of the suture is done with one pinch of the forceps. 

Cautions. — If there is considerable hemorrhage the wash- 
ing out of the bladder must not be neglected after the opera- 
tion is completed, as a large clot of blood in the bladder 
might cause much trouble. In removing the stitches be 
careful to remove them entire and not cut them on both sides 
of the knot, and leave a part of the suture to drop into the 
bladder and serve as a nucleus for a calculus. With Cutler's 
suture forceps this can hardly occur, as they cut the suture . 
and hold on to one end of it at the same time. 

Elytroplastv. — Elytroplasty resembles rhinoplasty per- 
formed by surgeons upon the face. It consists of freshening 
the edges of the fistula, as heretofore described, and then 
dissecting a flap from the wall of the vagina or buttock, and 
placing it into the fistula and making it adhere there by 
stitching it carefully to the freshened margin of the fistula. 
The operation has, of late years, fallen into disuse. 



VAGINAL FISTULA. 537 

Episiorraphy. — Where there is very extensive ulceration 
of the vaginal walls, and the case is complicated with ex- 
tensive cicatricle adhesions, episiorraphy is sometimes per- 
formed. It is comparatively an easy operation, and consists 
in paring the inner surface of the labia inajora and stitching 
the opposite sides together; or cutting the margin of the 
vulva and placing sutures so as to bring its sides together, 
and thereby obliterate the vaginal outlet. For at least ten 
days after the operation the patient should lie on her stom- 
ach with a, self-retaining catheter in the bladder (which 
must, of course, be removed and cleansed every two or three 
days), so as to prevent the urine from accumulating in the 
vagina before adhesions have formed. The menstrual flow 
thereafter must pass through the urethra with the urine. 

Kolpoklesis. — Kolpoklesis is similar to episiorraphy. In 
this operation the vagina is obliterated higher up, leaving per- 
vious as much of the vagina as possible. Professor Simon is 
the originator of this operation, and claims that over fifty 
operations have been performed in Germany with success. 

Simple Vaginal Fistul.e. 

These forms of fistulre open into the vagina, but do not 
communicate with either of the natural outlets of the body. 

They may be 

Blind fistula, 

Perineo-vaginal fis tula, 

Peritoneo-vaginal fistula. 
The blind vaginal fistula is usually caused from a cellu- 
lar abscess opening into the vagina. It may be situated on 
the anterior, posterior, or lateral sides of the vagina, but is 
most frequent on the lateral or posterior sides. They may be 
treated by injections of Calendula diluted, or, if chronic, may 
be injected with Solution of Iodine every two days till granu- 
lations are developed. Another good way to treat them is 
to wrap a sound or probe with raw cotton, and, after satur- 



538 EA TON ON DISEASES OF WOMEN. 

ating the cotton with Solution of Iodine, swab out the fistula 
thoroughly with it, repeating the application every two days. 

Perineo-vaginal Fistula. 

This form of fistula of the vagina opens through the 
perineum externally. It may be caused from traumatic in- 
juries to the parts, or be left after operations for lacerated 
perineum, on account of a failure of adhesion of a part of 
the surfaces which have been brought in contact. The treat- 
ment is similar to that in cases of blind vaginal fistula. 
Granulations must be stimulated till the fistula is closed. 

Peritoneo-vaginal Fistula. 

This is rarely seen. It sometimes may result from the 
leaving of a drainage tube too long after operations for 
ovariotomy. The fistula communicates from the vagina to 
the peritonaea! cavity, and allows of the introduction of at- 
mospheric air into this cavity, and through it portions of in- 
testine may protrude into the vagina. 

The Treatment consists in returning the intestine and 
stitching the fistulous walls together in the vagina after 
freshening the vaginal membrane around the fistula, or 
arousing adhesive inflammation by stimulating applications. 

Remedies. 

Cat. carh., Merc, iodid., Ars. alb., Phytolac, Nux, etc., 
may be indicated in this class of cases, on account of the 
condition of the general system homoeopathically indicating 
their use. Warm vaginal injections of Calendula water are 
usually of benefit, as well as being pleasant to the patient. 



LACERATIONS OF THE CERVIX UTERI. 539 



CHAPTER XLVII. 

LACERATIONS OF THE CERVIX UTERI. 

Lacerations of the cervix uteri in labor are of somewhat 
frequent occurrence, and are, doubtless, one cause of the ar- 
rest of normal involution of the uterus after confinement, 
and, consequently, one cause of sub-involution of the organ 
and of Areolar hyperplasia of the uterus as well. 'Their 
agency in the causation of these conditions has until quite 
lately been ignored or overlooked, and they are still but 
imperfectly appreciated by the mass of the profession. 

Lacerations of the cervix are liable to occur in cases 
where there is a rigid os uteri in labor, where drugs are ad- 
ministered to hasten delivery without giving sufficient atten- 
tion to causing relaxation of the os; also, in the use of for- 
ceps without first seeing that the os is fully dilatable, or in 
performing pedalic version and delivery under the same cir- 
cumstances. 

One object of this chapter will be accomplished if we 
can arrest the attention of the student so as to impress upon 
his mind the necessity of attention to the dilatability of the 
os, before giving Secale cor. to increase labor pains, or using 
forceps or resorting to pedalic version (except in extreme 
cases) until the os uteri is fully dilated or dilatable. In 
this way much may be done to prevent the sad consequen- 
ces resulting from disregard of these precautions. 

Lacerations of the cervix uteri may be slight or exten- 
sive. They may occur singly or multiple. The laceration may 
implicate the bladder and cause cervico- or, as it is sometimes 
called, utero-vesical fistula, or it may exist upon the posterior 
or lateral aspect of the organ, and affect the peritonaeum so 



540 EATON ON DISEASES OF WOMEN. 

as to cause Puerperal peritonitis or pelvic cellulitis ; or it may 
be slight and cause little trouble apparently for a time, un- 
til it is discovered that chronic metritis or Areolar hyperla- 
sia of the uterus, or hypertrophy or induration of the cervix 
are present, and the fact is evident on physical examination 
that these conditions were caused by laceration of the cervix 
in confinement. 

The fact that such results follow laceration of the cervix 
has caused me to be opposed to forcible, rapid dilatation of 
the cervical canal, or of incising it, as has been the practice 
of some upon (as it seems to me) every slight pretext. The 
tearing of the tissues with instruments, or incising them, is 
little less objectionable than their accidental laceration. 
Still, incision of the cervix and scarification of this part is 
a, favorite and constant practice with some. I am glad I 
never fell into this practice, which seems to me more and 
more objectionable the more experience I have in the treat- 
ment of the diseases of women. 

Prof. Emmet,* who has paid more attention to this sub- 
ject than any other physician living, so far as I can learn, 
says : 

"During the Autumn of 1862 I accidentally recognized 
the importance of this lesion, and at once instituted a surgi- 
cal procedure for its relief. The operation then devised has 
stood the only true test — that of time — and has been but 
little modified. From the above date I have continued to 
operate frequently, in both public and private practice. 

"February 8, 1869, I described the operation fully in a 
paper f read before the Medical Society of the County of 
New York. Before the same society, on September 28, 1874, 
I presented an article % on c Lacerations of the Cervix Uteri 
as a frequent and unrecognized cause of disease.' This last 

-Emmet's Prin. and Prac. of Gynaecology, p. 445. 

u f 'Surgery of the Cervix,' American Journal of Obstetrics, February, 1869. 

"J American Journal of Obstetrics, November, 1874. 



LACERATIONS OF THE CERVIX UTERI. 541 

paper was soon after translated by Dr. M. Vogel, and pub- 
lished in Berlin, June, 1875. Prof. Breisky, in the following 
year, published a favorable criticism* on the paper translated 
by Dr. Vogel, together with the report of fourteen cases suc- 
cessfully treated by him. 

"Ktiologry of Lacerations of the Cervix Uterio 

"Previous to collecting the statistical material for this 
work I had recognized and treated two hundred and nineteen 
cases of lacerations of the cervix in my private hospital. 
This shows that a little over sixteen per cent of all women 
who had passed under my observation, and had been impreg- 
nated, were found to have had laceration of the cervix. This 
proportion will seem to many a large one, and yet, as the 
record extends over thirteen years, doubtless many cases 
during that period were not recognized. It was fully six 
years after my first operation before I had gained experience 
enough to detect this lesion under its varied forms, while the 
treatment itself was not perfected until several years later. 

" To arrive at more definite results as to the frequency 
of this injury I have taken from my case-books the records 
of the last five hundred fruitful women coming under my 
care in private practice. The result is reached that 32.80 
per cent of all women under observation, who had been im- 
pregnated, and had suffered from some form of uterine dis- 
ease, were found to have laceration of the cervix. It is, of 
course, possible that this increase in the percentage is due in 
a measure, but not wholly, to the fact that cases were sent 
to me by general practitioners. But in few instances had 
there been a diagnosis made. 

" The average age of puberty for women who had lacera- 
tions was, as will be seen by table XXXIII, 14 years, and 

"*Zur Wurdignng des Narbenektrodiums des Muttermundes, und dessen 
Operativer Behandlung nacli Emmet, von Prof. Briesky in Prag. Wiener Med. 
Wochenschrift, No. 49, bis 51, 1876. 



542 



EATON ON DISEASES OF WOMEN. 





O 


O 


i— 1 


c 




b- 






Since last pregnancy, 


oc 


CO 


CT> 


lC 


CN 


as 




CM 


ill vpurs 


■^ 


iO 


iO 


c 


^ 


CM 




id 






a 


Criminal Abor- 






iO 






CM 


o 


o 


tion 
















sd 






















j 




































, 


a 


Miscarriages... 




"" 


I 






r ~ 


CM 


CM 






















o 

» 
a 
o 




















Large children. 


o 


io 


c-1 








CO 


CM 


■? 


















*"" 


3 




















<j 


















sO 


Q 


Craniotomy.... 










•" 




"~ < 


O 


a 




















D 






































^ 


















OO 


2 


Turning 


-t 




TJH 






r ~ 


OS 


— 1 


£ 


















>o 


K 




















£ 


















o> 


O 


Forceps 


- 


^ 


so 








o 

Ol 


CM 






















^ 
















1 


CO 


H 


Tedious 


CO 


iC 


b- 


r— 


-t 




o 


-sjH 


H 






M 








o 


o 

CO 


fa 




















O 
















1 


so 




Rapid 


?n 


u: 


b- 




CO 


1 — 


oc 

CO 


O 

oi 


















CM 




































1 


■^ 


a 


Natural 


■M 


cn 


o 


£> 


Ol 


-t 


1 — 

CM 

1 


t— 
CM 




iC 


CM 


00 


oc 


cr 


oc 






Percentage for each 


CO 


<3 


~* 


CO 


c 


-St 






le 


sion 


^t 


Tf 


o 

CO 


oc 


S£ 


lit 


I '* 










t-; 


co 


o 


^ 


— 


co- 


1 -* 




Total number for 






O 








SO 




each lesion 














1 - 








oc 


c 


CM 


— 


i — 


co 


. 


CM 


H 


First consulta- 


cr 


sO 


so 


■ 


OC 


CO 


• 


CO 




tion 


cc 


CO 

co 


co 


rv 


c 
co 


CO 
CO 




CO 
CO 
























C5 




sC 


Cn 


-* 


ir 


<c 


Tt 


1 


t- 


<< 




tM 


it. 


o 


Cn 


SC 


Tt 


: 


■<* 


H 


Marriage 






,_; 




— 




I : 


^ 


<5 




oi 


CN 


Ol 


Q 


CN 


c? 


: 


CM 


K 




















3 




*""* 


oc 


o 


c 


r— 


^ 


. 


o 


> 




c 


l> 


o 


c 


OC 


Tt 


• 


o 


< 


Puberty 


Tf 


CO 


-fn' 


u: 


CO 


Tt 


1 ; 


i—i 


















<D 


















bC 


















_cj 




































fl 








oo 










<D 








<D 










p 






a 


ns 














a 


^ 


'S3 








<D 






t 


"E? 


! ^ 






























"5 


■+: 


o 








3 


O 




a 
a 


. r- 

4 


^ 


> 






g 
'3 












^ 


"p 


"a 


o 


> 






+. 







t 


c 


H 


<J 




^ 


C" 


H 




c 


{z 







LACERATIONS OF THE CERVIX UTERI. 543 

at marriage 21.47 years. These averages approximate so 
closely to those of all women under observation, that it is evi- 
dent neither the time of puberty nor of marriage had any 
bearing on the cause of the lesion. These women first came 
under my observation at about the average age of thirty- 
three years and four months, the greatest deviation being for 
those who had suffered from backward laceration. While the 
number of cases is too small to give any importance to the 
circumstance, it is not entirely an accidental one, since it is a 
form of laceration which would produce the least disturbance, 
and then only later in life as the vagina becomes changed in 
shape. In one of the columns of the table will be found the 
number of the different forms of laceration, and their relative 
frequency. It will be seen that the injury on the left side is 
the most common, and double laceration the next. To es- 
tablish with some degree of accuracy the character of the 
labor most likely to result in laceration of the cervix, would 
be an important advance. I endeavored with great care to 
ascertain from each of these women the prominent features of 
the labor in which it was supposed the accident occurred. 
Notwithstanding I had so intelligent a class to deal with, I 
feel that the information gained is to be accepted only as 
approximating to the truth. The testimony of a patient as 
to her labors, and particularly the first one, to be of value, 
must be confirmed by careful observation on the part of the 
attending physician. From a priori inference I had been pre- 
pared to learn that rapid labor was the most common cause of 
laceration of the cervix. The contrary, however, has proved 
to be the case, as more than thirty per cent of the lacera- 
tions were attributed to tedious labor. This proportion would 
be greatly increased by the addition of the forceps cases, 
which properly should be placed under the head of tedious 
labor, since, we may assume, forceps were only employed for 
delivery after the labor had been prolonged. It will be 
noted that two instances of laceration occurred from mis- 



544 EATON ON DISEASES OF WOMEN. 

carriage, and ten as a consequence of criminal abortion. 
Since my attention has been directed to this subject, I have 
found the cervix lacerated in every instance where the patient 
admitted the fact of exposure to malpractice. And my sus- 
picions have been verified several times by the patient ac- 
knowledging the charge which I felt justified in making 
whenever I detected a laceration produced by discharge of 
the uterine contents before full term. It. can readily be un- 
derstood that laceration of the cervix would occur under these 
circumstances as well as in rapid labor where the parts are 
so quickly dilated; but as the result of a tedious labor, it is 
not so clear, since sloughing would then be a more likely 
consequence. If the delay was in the first stage of labor, with 
the os tardy in dilating, a condition of the soft parts might 
be established which would readily admit of the occurrence 
of this accident. But, as a rule, the effect of a tedious labor 
would scarcely be asserted until long after full dilatation of 
the cervix had been accomplished, I can not divest myself 
of the conviction that rapid labor will be found, on further 
observation, to be a, far more important factor in causing this 
lesion than has been indicated by this record. The propor- 
tion of rapid labors, as given, is much more likely to be cor- 
rect than the contrary. For it is a very natural error for a 
woman to exaggerate the time, and to regard a, labor as 
tedious, although it may have been a natural one in every 
respect. 

" We will now complete the consideration of Table 
XXXIII by reference to the last column, in which is re- 
corded the average duration, or the interval, since the last 
pregnancy o The average length of time in all forms of lacer- 
ation was found to be rather more than five years. The 
relative duration of this interval, with respect to any one 
special form of laceration, is not sufficiently marked for com- 
ment, with the single exception of the backward lacerations. 
In this form the state of qua si-sterility had existed for twice 



LACERATTOXS OF THE CERVIX UTERI. 545 

the length of time given for any other form of the injury. 
The proportion of these cases, as we have already noted, is 
smaller than any other, but the sterility was naturally pro- 
duced by the greater or less degree of retro-version, which 
existed as a result of the laceration extending into the pos- 
terior cul-de-sac, and causing contraction of the parts or tissues 
located posteriorly. 

"Menstrual Changes. — The average duration at puberty 
of the menstrual flow for the 164 women who suffered from 
laceration of the cervix was 4.78 days, while that on the 
general average for 2,080 women was 4.82 days. These 
averages are essentially the same, and, as there was no marked 
difference in the early history of menstruation, either as to 
the degree of pain or regularity, it is evident the condition 
at puberty would furnish no indication of subsequent liability 
to this lesion. 

Diagnosis. 

" Lacerations through the neck of the uterus are of more 
frequent occurrence than has been supposed. In fact, I 
doubt if a woman can give birth to her first child without 
partial laceration taking place; but if it is slight it heals 
rapidly and causes no difficulty afterwards. Even most ex- 
tensive tears are seldom recognized at the time of labor. 
The tissues are then so soft that, unless the rent has passed 
beyond the cervix into the vagina and connective tissues, it 
can scarcely be detected by a mere digital examination. 
Indeed, the occurrence of the accident, in all probability, will 
not even be suspected, unless an unusual amount of hemor- 
rhage should exist. 

"Lacerations in the median line are the most frequent, 
and those through the anterior lip are more common than 
those in the posterior one. When in the median line and 
confined to the cervix, these lacerations generally heal rapidly, 
leaving scarcely a cicatricial line to mark their course. This 
is due to the fact that the necessary recumbent position of 

35 



546 EA TON ON DISEASES OF WOMEN. 

the patient, which is enforced for some time after labor, keeps 
the raw surfaces in close contact by the pressure of the 
lateral walls of the vagina until they have become firmly 
united. 

"No serious consequences, therefore, are likely to follow 
this accident through the anterior lip of the uterus, unless the 
rent passes beyond the cervix through the septum into the 
bladder. Even when most extensive, the line may heal 
throughout, as there will have been no loss of tissue from 
sloughing. This will frequently be the result if proper atten- 
tion has been paid to cleanliness, by the use of vaginal 
injections of warm water, so as to prevent phosphatic deposits 
from the urine on the raw surfaces. 

" But, as a, rule, when the tear has been so extensive, a 
small vesi co-vaginal fistula will be left in front of the cervix. 
Or the laceration through the neck will heal from above 
downward, and leave at the bottom of the fissure a sinus, 
along which the urine will escape from the bladder into the 
uterine canal. Under the proper head this form of fistula 
will be treated of at length. Lacerations through the ante- 
rior lip generally occur in women who have borne a number 
of children, and in whom there exists great relaxation of the 
abdominal walls, and anterior obliquity of the uterus. 

"Lacerations through the posterior lip unite as readily, 
and the accident may not be suspected, unless the fissure 
should have extended sufficiently into the posterior cul-de-sac 
to set up an attack of inflammation. When cellulitis occurs 
at this point, and from this cause, it always induces a most 
intractable form of retro-version. Even when a laceration 
has been superficial on the vaginal surface, the cicatricial 
band, felt as a cord, will contract, and so shorten the cul-de-sac 
as to render it impossible to adapt any form of pessary to it. 
To restore the uterus to its natural position, a surgical pro- 
cedure has to be resorted to for the removal of this band, 
often with most unsatisfactory results. 



L ACER AT/0 XS OF THE CERVIX UTERI. 547 

"The history of the cases suffering from this form of 
laceration would indicate that the occurrence of the injury is 
due to the position of the occiput towards the sacrum. It 
is very rare for bad effects to remain after laceration either 
backward or forward, and when they do occur it is excep- 
tional. When, however, the laceration is in a lateral direc- 
tion, and extends beyond the crown of the cervix, a condi- 
tion at once arises which will defeat all the reparative efforts 
of nature. In practice, therefore, we have to deal chiefly 
with the consequences of lateral lacerations, and the effects 
are more marked when the lesion is doable than w 7 hen con- 
fined to either side. Whenever the rent has extended to the 
vaginal junction, or beyond, there will exist a tendency for 
the tissues to roll out from w T ithin the uterine canal as soon 
as the woman assumes the upright position. The posterior 
lip of the cervix naturally catches on the posterior vaginal 
wall, as the uterus after a recent delivery is larger than 
natural, and lower in the pelvis from its increased weight. 
When the flaps formed by the laceration are once separated, 
their divergency becomes increased by the anterior lip being 
crowded forward in the axis of the vagina. This will be 
towards the vaginal outlet in the direction presenting the 
least resistance, while the same force naturally crowds the 
posterior lip backwards into the cul-de sac. From thus forc- 
ing the flaps apart a source of irritation is at once established, 
which arrests the involution of the organ. The angle of lacer- 
ation soon becomes the seat or starting-point of an erosion, 
which gradually extends over the everted surfaces. With 
the increased size and additional weight of the uterus, in- 
duced by congestion, the tissues gradually roll out as far as 
the neighborhood of the internal os. As the laceration fre- 
quently occurs in consequence of rapid labor, or from its hav- 
ing been necessary to apply the forceps or to use traction, 
the perineum is frequently ruptured. 

" Sometimes the laceration heals while the woman remains 



548 EATON ON DISEASES OE WOMEN. 

in bed after her labor, but when she gets up the surfaces 
soon become the seat of an extensive erosion, which bleeds 
readily. As the uterus begins to increase in size a profuse 
cervical leucorrhoea follows, and, in consequence of a frequent 
show, the patient seeks relief. She will state her inability to 
stand with comfort, complaining of a continual backache, 
with pains down her limbs, sometimes irritation of the blad- 
der, and, as a rule, marked nervous disturbance. 

" Until recently, this condition of laceration was univer- 
sally mistaken for ulceration, and sometimes for the early 
stages of epithelioma, and for corroding ulcer of the uterus. 
To heal this ' ulceration' would long baffle every mode of 
treatment, or, if any improvement took place in the patient's 
condition after a protracted rest in the recumbent position, a 
relapse would follow again and again, with every attempt at 
exercise. Such a case passed from one physician to another, 
until eventually the leucorrhoea ceased, and the profuse men- 
struation diminished as the surfaces, from the frequent appli- 
cation of caustics or the cautery, became cicatricial in char- 
acter. Nevertheless, a woman in this condition gradually 
became a confirmed invalid while the hypertrophy of the 
uterus remained, and from impairment of her general health 
the nervous element became most prominent. 

'•When the laceration has been complete, but confined (o 
one side, the rolling out is not so extensive, nor is the appar- 
ent size of the cervix so large as in the previous condition, 
but it is difficult often at first sight to detect the injury. A 
partial obliquity of the uterus in the pelvis is thus produced 
by crowding the cervix towards the uninjured side, and this 
surface and the flattened lacerated portions may present a 
common plane to the posterior wall of the vagina on which it 
rests. As the flaps separate, the two edges and the unin- 
jured side form a, tripod, with two legs shorter than the third 
one, so that the fundus must necessarily be tilted toward the 
injured side. Cellulitis is a most common result of this 



LACERAT10XS OF THE CERVIX UTERI. 549 

accident, and is generally situated between the folds of the 
broad ligament on the side of the laceration. The effect of 
the cellulitis is to shorten the ligament, and the fundus will 
be fixed towards the injured side. This causes the parts which 
have been torn down to the vaginal junction, or beyond, to 
project into the passage, and as they are covered by a reflex- 
ion of the vaginal tissue over this part of the uterine body, 
just above the terminating point of the laceration, the effect 
to the eye is a length of cervix on that side equal to the 
uninjured portion. The apparent os is always more patulous 
than in health, and this condition is readily accounted for 
from the evident existence of disease within the uterine 
canal. Moreover, the deception is still maintained by the 
passage of the sound in the median line to the fundus, for 
its use gives no indication of the true condition. The explan- 
ation is, that the sound passes through a. patulous os, along 
the angle of the rent on one side of the cervix to the horn 
of uterine canal on the opposite side. So deceptive is the 
condition that I have been frequently consulted as to the pro- 
priety of amputating an enlarged or enlongated cervix, when 
if a small portion only of the apparent enlargement had been 
removed the peritonseal cavity would have been opened. 
The cervix is never so large as it seems to be, and the line 
of junction with the vagina is equally deceptive. It is, 
therefore, a wise procedure, in any doubtful case, to place the 
patient for examination on her knees and elbows. On the 
introduction of the speculum the vagina becomes distended 
by atmospheric pressure, and by the aid of gravity the uterus 
is brought into its proper position. The true line of junction 
with the vagina will be then well marked, and only the actual 
length of the cervix will project above the vaginal surface. 
In a case of laceration on one side, extending to or beyond 
the vaginal junction, the fissure will be detected without diffi- 
culty in this knee-elbow position. By the weight of the 
uterus its axis in the pelvis will be brought in line to cor- 



550 EATON ON DISEASES OF WOMEN. 

respond with that of the vagina, so that the depth of the 
cleft through the tissues can be appreciated at a glance." 

Treatment. 

As before remarked, these lacerations sometimes exist, 
and are not discovered for a long time. The normal healing 
process is ordinarily sufficient to cause healing of the lacer- 
ated surfaces, either by adhesion of the opposing tissues or 
by the formation of mucous membrane over them. When 
the lochia is continued three or four weeks, it is advisable 
to make a physical examination to discover if laceration of 
the cervix be the cause of the discharge, and, if so, we may 
apply some stimulating local application to the unhealed lac- 
erated surface. A solution of Iodine, 10 grs. to the oz., is 
perhaps as good an application as can be made, using a soft 
brush to apply it, and making an application every three 
days. This is ordinarily all the treatment required. 

The operations performed by Prof. Emmet in cases of 
laceration of the cervix are, to my mind, objectionable. 
With high regard for the eminent service he has rendered 
the profession and humanity, we still believe he has allowed 
his zeal in this direction to carry operative procedure fur- 
ther than the necessities of these cases require. The cut- 
ting away of some of the tissue of the cervix in order to 
make a fresh surface, causes loss of substance, which is very 
objectionable in its relation to future gestations and deliv- 
eries, by reason of the impediment which is thereby offered 
to the free relaxation of the muscular fibers surrounding the 
os and cervical canal. The cicatrix formed by the union of 
the lacerated tissues of the cervix is some impediment to 
the delivery of children, in future pregnancies at best; and 
the cutting away of any part of them and then securing ad- 
hesion, can but increase the difficulty. We do not appre- 
ciate the need for these operations. They can do little to 
lessen the hypertrophy or Areolar hyperplasia of the uterus, 



LACERATIONS OF THE CERVIX UTERI. 551 

sometimes very largely caused by them, but not necessarily 
remedied when the laceration which is already healed is cut 
and stitched together. 

Rest, good diet, cleanliness, pure air, etc., are the neces- 
sities in these cases, combined with such remedies as are 
homoeopathically indicated by the symptoms in each partic- 
ular case. These suggestions apply especially to recent 
cases. Cleanliness of the parts and healing is to be secured 
by semi-daily injections into the vagina of tepid castile soap 
and water, followed by Calendula water. 

The chronic case (if found healed) is certainly better let 
alone, so far as cutting is concerned. The resulting indura- 
tion, ulceration, hypertrophy or Areolar hyperplasia, may 
demand treatment; but as a laceration, we are of the opin- 
ion it needs none. 



552 EA TON ON DISEASES OE WOMEN. 



CHAPTER XLVIII. 

DISPLACEMENTS OF THE UTERUS. 

There is no disease to which women are liable of so much 
importance, and which, in my opinion, is so poorly under- 
stood (excepting cancer and phthisis), as Uterine displace- 
ments. 

As this is read by the general practitioner, I feel sure he 
will at first be disposed to differ with me. He will at once 
say that it is very easy to diagnose cases of displacement, 
and he may be sanguine enough to think he knows how to 
treat them. This is likely to be the case if he has had but 
little experience. Most young physicians are sanguine on 
all departments of medicine, but especially so upon the de- 
partment of "Diseases of Women." And if there is one dis- 
ease they imagine they understand it is displacements of the 
uterus. I hope their opinion is well founded, for they will 
have need enough for their knowledge in actual practice. 

The student should first familiarize himself with the nor- 
mal condition of the uterus and its appendages by dissec- 
tion, after having studied thoroughly the anatomy of the 
pelvic and abdominal organs. I say abdominal organs, for 
there is as much depends upon a knowledge of the anatomy 
of the abdominal viscera in diagnosis and treatment as there 
is upon an understanding of the anatomy of the pelvic 
viscera. 

Just here, to my mind, appears the error into which so 
many fall. They fail to take into account the influence 
which the abdominal organs exert in producing displacements ; 
neither do they take it into account in the treatment. 
Hence, many failures result ^vhere success might be just as 



DISPLACEMENTS OF THE UTERUS. 553 

well achieved, if the case was properly understood. They 
seem to proceed as if there was a division membrane, like 
the diaphragm, between the pelvis and abdomen. I was told 
not long since by a medical gentleman of some pretensions 
that there was such a condition of the anatomy of the parts 
that the abdominal viscera never could press upon the pel- 
vic. This he stoutly maintained against the expressed views 
of several medical gentlemen then present. We can only 
wonder where he obtained such erroneous ideas. Still, I have 
seen very many physicians who practice in these ailments as 
if they believed in this kind of anatomy of the parts. 

The ordinary practice in these cases seems about as absurd 
to me as the former indiscriminate use of venesection, which 
is now so generally abandoned. I hope that within the next 
decade the universal use of pessaries will also be given up 
(as I believe caustic applications will also be), which have had 
their day of almost universal use by the old school (would that 
homoeopaths had kept entirely clear of their employment). 

Some homoeopaths have gone to the other extreme, of 
depending entirely upon internal remedies in the treatment 
of displacements. This practice is about as unwise as the 
other. Great good is accomplished with the use of homoeo- 
pathic remedies in this class of cases, by relieving congestion 
and inflammation, and also in giving tone and strength to the 
tissues of the uterus and its appendages. They may also do 
very much to aid in the treatment of displacements by re- 
storing the normal functions in the liver, kidneys, spleen, etc., 
which may in some cases be remote causes of the difficulty. 
But remedies alone are not adequate to rectify a very large 
proportion of the displacements of the uterus with which we 
meet. I have taken pains to test this matter, and have had 
very good opportunities to do so, and did so in good faith, 
desiring, if possible, to cure without mechanical appliances of 
any kind. 

But I can not commend the reliance upon remedies alone ; 



554 EATON ON DISEASES OF WOMEN. 

but claim for them the credit of being very great aids in the 
cure of displacements. I very much prefer, however, the 
physician who depends upon remedies alone to the one who 
relies wholly upon pessaries (especially the great number of 
hard pessaries which have been invented and used), as they 
do very much injury in very many cases, and good only in a 
very few ; w T hereas, remedies are a benefit in all cases when 
properly selected. I have made a cut to represent the normal 
position of the pelvic viscera and small intestines in the ab- 
domen (see Plates I and II). 

Plate II represents the bladder as partially distended. 
When empty the uterus is inclined a little more forwards in 
the pelvis than is represented in the cut. The vagina and 
rectum are represented as distended partially, that they may 
be understood; but the student must recollect that ordinarily 
the folds of the vagina fill it up, though the vaginal walls 
are loose and flabby; and he will also bear in mind that 
sometimes the rectum is more distended, at others empty 
and collapsed. 

He will please note that a line drawn from the promon- 
tory of the sacrum to the lower portion of the pubis would 
intersect the cervix uteri at a point just above the vaginal 
juncture; (he will also notice) that the os uteri is directed 
backwards and downwards, towards the hollow of the sacrum; 
that by taking a pencil and making a line from the fundus of 
the uterus to the os, through the uterine cavity, and thence 
through the centre of the vaginal canal to the os vaginam, 
he would have the arc of a circle. 

It is always well to bear in mind this circular shape. 
He will also please notice that when the rectum is distended 
it will press against the cervix, that when the bladder is dis- 
tended it presses the uterus backwards; also, and most im- 
portant of all, that the small intestines rest in contact with 
and upon the uterus and bladder. 

Now, in case the uterus is displaced, the intestines also 



DISPLACEMENTS OF THE UTERUS. 555 

become displaced, and fall into the space normally occupied 
by the uterus. It is easy by studying the Plate to see how 
women, by compressing the upper portion of the abdomen 
with corsets and dragging it clown with the weight of clothing 
worn by many fastened about the waist, have pressed the 
intestines down upon the uterus, and thereby displaced it. 
Now, if the physician forcibly replaces the organ and presses 
it upwards with pessaries in the vagina, the uterus is placed 
between two pressures, one from above, another from below. 
This double pressure would likely produce a flexion, or a 
bending of the organ upon itself, or cause inflammation. 
Now, it has for many years appeared to me to be a rational 
and philosophical practice, to lift up the abdominal viscera 
by some means, and give the uterus room to occupy its 
normal position. If this is not sensible and philosophical 
practice, then my judgment is entirely wrong. Holding this 
view, I deem it of vital importance to study in the outset 
how this can best be accomplished. Why this idea has been 
so universally ignored by writers upon the diseases of women 
I can not conceive. The great aim seems to have been to 
demonstrate the advantage of some particular pessary to press 
the uterus forcibly into position, irrespective of the superin- 
cumbent weight resting upon it. 

Dr. Emmet* seems nearly to have grasped the idea, 
which I had already published in 1878 in the Cincinnati 
Medical Advance, viz.: The influence of atmospheric pressure 
in maintaining the uterus in situ. He says : " I often give 
my patients instructions to assume the position on the knees 
and elbows at night, and after taking out the instrument 
[pessary, I suppose, though he does not mention, either di- 
rectly or indirectly, what he means], to open with the fin- 
gers the outlet of the vagina while in this position, so that 
the uterus may be carried well up into the pelvis by atmos- 
pheric pressure." 

* Emmet's Prin. and Prac. Gyonsecology, p. 129, 1879. 



556 EATON ON DISEASES OE WOMEN. 

Well, why not open the vagina while the patient is erect? 
Does not the atmosphere j3ress with as much force upwards 
as downwards? Now, it is clearly the result of taking off 
the weight of the abdominal viscera by the knee-elbow posi- 
tion that enables the atmosphere to act so forcibly upon the 
uterus in its replacement; but he gives no hint of this, nor 
does he or any one else mention that lifting off the abdom- 
inal viscera by position, causing them to draw away from 
the pelvis, thereby creating a partial vacuum in the lower 
abdomen, is the main cause of such favorable results from 
atmospheric pressure. I therefore claim this idea of the pro- 
duction of a partial vacuum, by lifting up the abdominal vis- 
cera, in connection with atmospheric pressure as a support to 
the uterus, as original, in the treatment of displacements, 
though Dr. Sims, in 1854, in a public lecture, and later in 
his work on surgical diseases of women, presents the idea of 
atmospheric pressure aiding in the reposition of the retro- 
verted uterus when the patient is placed in the knee and 
elbow position. He fails to mention that thereby a partial 
vacuum is produced by the weight of the bowels falling for- 
wards and upwards while in this position. 

Now, if the uterus is pressed into position, as both Profs. 
Emmet and Sims say it is, while the patient is in the knee 
and elbow position, and the vagina is dilated for the admis- 
sion of air, why not lift up the abdominal viscera, create a 
partial vacuum while the patient is erect, and let the atmo- 
sphere act as a pessary? If not, then why not? 

Prof. H. F. Campbell, of Georgia, has invented a glass 
tube similar to a glass speculum, bent at its upper extremity 
for the purpose of admitting atmospheric air in cases of pro- 
lapse; but I find no mention made of the necessity of con- 
joining with its use some means to lift up the abdominal 
viscera, and leave a partial vacuum into which the uterus 
might readily rise while the patient is in the erect position. 

All must concede that the atmosphere presses upwards 



DISPLACEMENTS OF THE UTERUS. 557 

with as great a force as downwards; and if we can maintain 
the abdominal viscera in a position upwards towards the 
chest, as is effected while the patient is in the knee-elbow 
position, we may have the assistance of the atmosphere at 
all times, if we will but admit it into the vagina. How to 
accomplish this is the next question. 

Herein lies the difficulty; but it must be accomplished, 
or little success will attend our efforts to cure many cases 
of displacements of the uterus. The gynaecologist must give 
to this matter personal and careful attention in each patient; 
and he must use ingenuity in the application of means to 
various cases, and secure the co-operation of his patient 
as well. 

There are patients with small abdomens, especially in the 
spare built, which may baffle the most experienced and skill- 
ful, in which instances rest in the recumbent position upon 
the side, with a pillow placed under the hips, and a small 
speculum in the vagina (a part of the time), will be the only 
alternative ; but with those whose abdomens are of some 
size an elastic abdominal supporter (called by my friend, 
Prof. Ludlam, abominable supporter, and sneered at by many 
others) is the efficient means to accomplish the lifting of the 
abdominal viscera off from the uterus, and leaving space for 
it to occupy its normal position. An improvement of the 
" London Abdominal Supporter," which I have had made 
by Max Wocher & Son, of Cincinnati, I find the most desira- 
ble, except in cases of extremely pendulous abdomens, when 
the silk elastic band is preferable. (See Plate XII.) 

In adjusting my supporter care must be taken that it is 
not too large. It should be small enough so that when 
adjusted, nearly the whole length of the elastic straps pass- 
ing around the body is required, as otherwise we have not 
sufficient elasticity to make them comfortable. The lower 
straps must always be buckled tighter than the upper, so as 
to cause pressure upon the extreme lower part of the abdomen, 



558 EAT OX ON DISEASES OF WOMEN. 

and as the straps are tightened to lift the abdomen upwards. 
This necessitates the discarding of corsets and all clothing 
fastened about the waist, having it supported from the shoul- 
ders instead. Conjoin with this the insertion into the vagina 
during the day, for an hour or two, of a round speculum, 
having the knees widely separated, with the patient reclining. 

This makes up the plan of treatment which I have suc- 
cessfully followed for about twenty years, using means to 
replace versions, prolapse, and flexions, which I will mention 
in connection with the special description of each, occasion- 
ally resorting to the inflatable rubber pessary in cases where 
we can not secure the co-operation of the patient in the former 
mode of treatment. 

What I have written I intend as simply a statement of 
the, general principles of treatment applicable to all displace- 
ments, and inflammation of the uterus or cervix as well; 
yes, and I may say in cases of inflammation of any of the 
pelvic viscera, but not in cases complicated with peri-metritis 
or peritonitis, as in these cases the pressure of the sup- 
porter (elastic though it is) can not be endured; and we 
must resort to the recumbent position till the tenderness is 
removed. 

I v can only account for the contemptuous remarks which 
have been made against abdominal supporters on the suppo- 
sition that where the} r have been recommended it has been 
left to the patient to purchase and adjust them, and the 
patient, failing to appreciate the object of their use, has 
made of them abdominal compressors, instead of abdominal 
supporters, in which case the term abominable is very cor- 
rectly applied by Prof. Ludlam, as compressing the abdomen 
in its entirety, or from above, would tend to produce dis- 
placement, if it did not exist, and prevent a cure where it 
already existed. But the fact that their improper use would 
do harm, does not prove that their proper use could do no 
good. If it did, then on the same theory, we could condemn 



DISPLACEMENTS OF THE UTERUS. 559 

every mechanical appliance in gynecology and surgery, as well 
as every remedy in the materia medica. 

Supports of the Uterus. — The uterus is made, by an All- 
wise Creator, freely movable in the pelvis and lower abdomen 
to subserve the purpose of gestation; for this reason the 
folds of peritonaeum, called the broad ligaments, are loose 
and freely movable. They, in a state of health, offer no 
impediment to the rise of the uterus in tlie abdomen when 
enlarged from pregnancy or other causes, and can offer little 
resistance to its displacement downwards, backwards, or for- 
wards, though they in some measure act as stays to prevent 
lateral displacement. These, with the vaginal walls and the 
connective tissue, have been considered the supports of the 
uterus. They appear rather flimsy, to say the least, and 1 
never felt satisfied that I understood the supports of the 
uterus till I thought of the influence of atmospheric pressure 
in sustaining it in its normal position. Whether right or 
wrong, I present the idea to the profession, hoping its truth 
or falsity will be demonstrated more fully by others. Of 
the correctness of the plan of treatment of displacements on 
the general principles, which I have stated I have no doubt, 
having verified it by twenty years of trial. 

The weight of the abdominal organs must be removed in 
some manner from pressing upon the uterus, or it is very 
evident the supports of the uterus will give w T ay. Normally 
the folds of peritonaeum covering the intestines with the con- 
nective tissue, serve to maintain their weight; but when 
pressed upon from above with corsets or considerable weight 
of clothing, the folds stretch out and the intestines rest as a 
dead weight upon the uterus and bladder. Their treatment 
has been sometimes better than the theory regarding them. 

Physicians have been in the habit of introducing enough 
atmospheric air, I judge, by their frequent use of the spe- 
culum and by means of various pessaries used; and when 
they have made the patient recline most of the time, they 



560 EA TON ON DISEASES OF WOMEN. 

have met with some success. They were unwittingly using 
atmospheric pressure, and gave the credit to the pessary. 

The beneficial effect of atmospheric pressure upon the 
engorged capillaries of the uterus and vagina present in most 
cases of displacements of the uterus is well described by Pro- 
fessor Emmet.* He says, after speaking of the advantage of 
the knee-elbow position, and the effect of atmospheric 
pressure in replacing the uterus when the patient is in this 
position, with the vagina dilated to admit the air, "that the 
vessels are to a great extent emptied by the pressure of the 
atmosphere and by gravity. The pressure also is uniform 
and not confined to a portion of the tissues, as would be the 
case with an instrument. But more particularly from the 
natural elasticity of the pelvic tissues, there would be no 
persistent traction exerted on the veins to compress them, 
since this same elasticity would soon establish an equilibrium 
by expelling a sufficient quantity of air from the vagina." 

The relief of this capillary congestion is one of the 
objects to be attained in the successful treatment of dis- 
placements. 

The Cellular Tissue. — Without doubt the cellular or con- 
nective tissue normally exerts considerable influence in sus- 
taining the uterus in situ. In displacements this tissue is 
more or less torn or stretched, and cellulitis is not an infre- 
quent complication of displacements. Very often, however, 
when the cellulitis is mild in degree, it is overlooked ; but its 
results are manifested in adhesions which in chronic cases 
are so often found, and which very materially interfere with 
the means used to replace and maintain the organ in position, 
and sometimes offer resistance it is impossible to overcome. 
In other cases, the efforts at replacement break loose the 
attachments formed, and cause a new attack of cellulitis. Of 
course, it is not to be expected that atmospheric pressure 
will be sufficient to tear loose the uterus where these attach- 

* Emmet, Diseases of Women, p. 129. 



DISPLACEMENTS OF THE UTERUS. 561 

ments have formed ; but it may sustain the uterus after it is 
replaced by other means, if the weight of the abdominal vis- 
cera is removed; and after a time the cellular tissue will 
become healed, and attached in its normal position. 

Symptoms. 

There are certain symptoms which are generally indica- 
tive of displacements of the uterus, and which should lead 
the physician to make a, physical examination to determine the 
nature of the difficulty which may also be produced by inflam- 
mation, in part, it is true; but when taken in connection with 
the absence of differential symptoms of heat, fever, etc., pres- 
ent in inflammation, may be quite characteristic of displace- 
ments. 1 will mention pain in the pelvis, a sense of weight 
or bearing down in the pelvis and lower part of the abdo- 
men, pain in the small of the back, constipation, painful and 
frequent micturition, pain in the iliac region, nausea, impaired 
appetite and digestion, painful menstruation, colicky pains in 
the abdomen, etc., as among these symptoms. When we have 
a considerable number of these symptoms present in the case, 
whose history shows that it has been somewhat chronic (and 
in some recent attacks), we may conclude that there is pres- 
ent some displacement of the uterus, and feel justified in 
making a vaginal examination to confirm the diagnosis, and 
the better to determine the means to be used for its relief. 

The diagnosis of the various forms of displacement I will 
mention under their proper heads. 

Etiology. 

Falls, jumping from a carriage or from any elevation, lift- 
ing heavy weights, constipation, neglect to empty the bladder 
at suitable intervals, tumors in the walls of the uterus or in 
its cavity, inflammation of the organ, pregnancy, rising too 
soon after confinement or a miscarriage, unskillful attention 
in confinement, the compression of the abdomen with corsets 

36 



562 EATON ON DISEASES OF WOMEN. 

or otherwise, great fatigue, general debility, etc., etc., may 
tend to cause uterine displacements. 

Treatment. 

General principles of treatment have been mentioned in 
the general remarks I have made upon displacements, as 
regards the necessity of taking off any superincumbent weight 
resting upon the organ, and the advantages of atmospheric 
pressure when conjoined with proper position of the patient, 
so as to take off the weight of the bowels at the same time, 
or using means to keep them up in the abdomen till their 
attachments grow strong, and capable of holding them up. 
I will now mention some other points in treatment which are 
applicable to all cases of displacement, leaving the discussion 
of the treatment of special forms, for consideration under 
their several heads. First, rest is an important injunction. 
Repeat it often. Secondly, the use of the warm hip bath, 
and warm water vaginal and rectal injections, repeated about 
twice a day, are of general application and benefit. Thirdly, 
keep the feet and limbs warm if possible, the mind quiet, the 
digestion and appetite good. Attention to these points will 
be of use in every form of displacement. Generally Nux, 
Bell., Aeon., Sepia, Hyosc, or Cim. are indicated remedies. 

Aconite, for nervousness ; tenderness ; fever, etc. 

Bell., for the stupid, tired feeling; pain in forehead; 
pressing pain in the bladder, etc. 

Cini., for pain in the ovaries. 

HyosCo, for despondent symptoms; disposition to weep; 
loss of energy; hysterical symptoms, etc. 

Nux, for weakness ; loss of appetite ; constipation; pain 
in back, etc. 

Sepia, for pain in the loins and back, accompanied with 
a leucorrhceal discharge. 



Plate XVIII. 




COMPLETE INVERSION OF THE UTERUS. 



INVERSION OF THE UTERUS. 563 



CHAPTER XLIX. 

DIFFERENT FORMS OF DISPLACEMENTS OF THE UTERUS- 
INVERSION OF THE UTERUS. 

Displacements may be dowmvards, backwards, forwards* 
sidezvise, or upzvards. 

Downward displacement of the uterus is termed prolapsus 
uteri. If complete, so as to appear externally, it is termed 
procidentia (though the terms prolapse and procidentia were 
formerly used as synonomous) . 

The displacement of the fundus backwards into the hol- 
lo \v of the sacrum is termed retro-version, and when the uterus 
is bent backwards upon itself in the form of a half circle, it 
is termed retro-flexion. 

When the fundus is bent heavily forward against the pel- 
vis, and somewhat prolapsed also, the os being carried back- 
wards into the hollow of the sacrum, it is termed ante-version. 

When bent upon itself forwards, it is termed ante-flexion. 

When tipped to either side, it is termed lateral version. 

When carried too high in the abdomen, it is termed up- 
ward displacement or elevation. 

When turned inside out, it is called inversion of the 
uterus. 

Inversion of the Uterus. 

Inversion of the uterus may be partial or complete. (See 
Plate XVIII.) In partial inversion the fundus is turned 
into itself. In complete inversion, the entire organ is turned 
inside out, or completely inverted. In order that inversion 
may take place, it is necessary that the organ be enlarged. 
In its normal and unimpregnated state it can not become in- 
verted. Inversion will not often occur in the practice of 



564 EATON ON DISEASES OE WOMEN. 

the careful, skillful physician ; but he may be called upon to 
treat a case which has resulted from the carelessness or igno- 
rance of some one else. As a result of tumors in the fundus 
it may become inverted in occasional instances, although the 
patient has never been pregnant. B. Langenbeck* exhib- 
ited the inverted uterus of a woman who had never been 
pregnant. On the inverted fundus was seated a fragile sar- 
comatous, heterologous growth of broad basis the size of a 
walnut. Inversion of the uterus is most likely to result in 
the puerperal state after delivery, while the uterus is en- 
larged in its entirety, and the tissues are flabby. 

Inversion of the uterus may be acute or chronic. In the 
acute or recent state, while the os is dilated, it is of the 
utmost importance to recognize the difficulty and restore the 
organ immediately, as in the chronic state it is very hard to 
replace, and the patient is liable to die from shock or hemor- 
rhage in a very short space of time after its occurrence. 

There are cases, however, where very little disturbance 
is produced in the system by inversion, owing usually, I 
think, to the anaemic condition of the patient, and want of 
nervous sensibility. A woman once walked into iny office 
with a completely inverted uterus dangling between her 
limbs (thinking it to be a falling of the womb), and stated 
that she was attended by a midwife in confinement about 
three weeks previously; that before she rose from her bed 
this tumor began to appear, and the midwife had pressed it 
up into the vagina several times, but it would not stay. On 
examination I found the case to be one of complete inver- 
sion of the uterus, with the necessary prolapse of the blad- 
der and vagina. I proceeded to replace the organ at once, 
which I succeeded in doing without much trouble in less 
than an hour. I know that subsequently she had two chil- 
dren; but for the last ten years I have lost sight of her. 

Some authors represent complete inversion as occurring 

*Mecl. Centr. Zeitung, 1860; also, in Barnes, p. 623. 



INVERSIOX OF THE UTERUS. 565 

entirely within the vagina. Such cases must be very rare. 
Generally, the uterus is very large in cases of inversion, and as 
it is inverted and is pressed downwards, it emerges from the 
os vaginam and drags with it the vagina and bladder, the broad 
and round ligaments, the ligaments of the ovary, and in some 
instances portions of intestine into the cavity of the inver- 
sion. The rarity of the difficulty may be learned from the 
remarks of Dr. West.* He says : " No instance of uterine 
inversion in the recent state has come under my observa- 
tion." " The Annals of the Dublin Lying-in Hospital and 
those of the London Maternity Charity illustrate the rarity 
of the accident, since it was not once met with in a total of 
140,000 labors." 

Etiology. 

It is ordinarily supposed that inversion of the uterus is 
due to traction made upon an adherent placenta ; but it may 
occur independently of this cause. Dr. Schroederf says: 
"Inversion is doubtless brought about in this way: the uter- 
ine foundation, or base of the tumor, which consists of normal 
uterine tissue becomes atrophied (either disappearing or un- 
dergoing fatty degeneration), by means of the pressure which 
the tumor exerts. A gap is thus formed in the firm contractile 
tissue, the tumor sinks into the cavity of the womb, and is 
driven towards the mouth by its own weight and the con- 
tractions of the organ. The os then opens and the tumor 
sinks into the canal of the cervix, and thus, the adjacent por- 
tions of the uterine wall being drawn down, a complete e ver- 
sion is gradually accomplished. In some cases, however, 
after the tumor has sunk a certain distance into the cavity 
of the uterus, the inversion is rapidly accomplished by means 
of uterine contractions." 

This is a very good description of the modus operandi 
of inversions occurring from tumors in the fundus. It may 

* West, Diseases of Women, p. 231. 
tZiemssen's Cyclopaedia, Vol. X, page 215. 



566 EATON ON DISEASES OF WOMEN. 

be added, that traction upon a uterine polypus whose pedicle 
is attached at the fundus may invert the organ. We may 
also say that pressure with two or three ringers upon the 
fundus through the abdominal walls, soon after delivery may 
indent the fundus, and the process of inversion may go on 
gradually, as it does in cases of tumors of the fundus, till 
the organ is completely inverted. 

This indentation may be made by the patient, or the nurse ; 
or a child climbing over the bed of its mother might put its 
little hand upon its mother's abdomen, and the force which 
it could exert, might start an inversion (if the mother had 
not been long delivered). This is a point of much import- 
ance in medical jurisprudence, or would be in case the physi- 
cian had a case of inversion on his hands, and also a suit for 
malpractice for producing it in the delivery of the placenta 
unskillfully. This indentation by the mother, the nurse, a 
child, or any one, might not produce for a time any more 
serious symptoms than pains of an intermitting character, which 
might readily be mistaken for ordinary after-pains, and hence 
the physician would fail to recognize the partial inversion 
which perhaps he is blamed for, as well as for producing it 
by unskillfulness, when in reality he is not in the least to blame. 
Besides, there might be a thickened condition of the tissues 
of the fundus, tending to the formation of an intra-mural fibrous 
tumor, or there might be already existing a tumor of some size in 
the walls of the fundus, which caused the depression in it, 
as soon as the uterus was left empty by the delivery of the 
child and placenta ; and inversion may also result from irreg- 
ular contractions of the muscular tissues of the womb. 

By these remarks, I do not wish to deny that inversion 
may be produced by undue traction upon a placenta which 
is adherent to the fundus. I most cheerfully acknowledge 
this might be the case ; but I wish to impress the student with 
the idea that it occurs from various causes independently of this. 



INVERSION OF THE UTERUS. 567 

Diagnosis. 

The diagnosis of a case of inversion is not so easy as 
might at first be supposed, especially if the case be one of 
long standing. It is most likely in a chronic condition to be 
mistaken for a fibrous polypus. The fibrous polypus is desti- 
tute of feeling, while the inverted uterus is usually somewhat 
sensitive. This is not always the case, however, as it some- 
times becomes lost to sensibility. While partially inverted 
it has much the appearance of a polypus. We can pass the 
uterine sound into the os two or three inches, and sometimes 
further, and sweep the sound around the apparent tumor, 
and seem to feel the attachment of the pedicle at the fundus 
of the uterus. 

Sometimes in these cases we can make out the diagnosis 
by rectal examination, and be able to pass a finger into the 
circle formed in the inverted fundus, and feel the sound 
passed into the bladder. In other instances it is impossible 
to do this, and we have to rely partially upon the history of 
the case. 

In uterine polypi we usually have a history of frequent 
and profuse hemorrhages, dating back several years, while in 
inversion, although we sometimes have much hemorrhage, 
the time elapsing since its commencement is shorter (generally 
but a few weeks), for if of long duration complete inversion 
would have occurred. And even here we may be mistaken, 
for I have known a uterine polypus to produce no hemorrhage 
till of considerable size. A slight menstruation usually takes 
place from the surface of the tumor if it be the inverted 
uterus, which never occurs from the surface of a fibrous poly- 
pus. The recent case following confinement is usually easily 
recognized if complete, by its size, its bleeding surface, or the 
partially adherent placenta, the shock to the system, taken 
in connection with the recent delivery of a living child, and 
the impossibility of a large polypus being retained in the 



568 EA TON ON DISEASES OF WOMEN. 

uterus during healthy gestation, and by the fact that the 
tumor was not present when the child was delivered. 

Complete prolapse of the uterus may simulate complete 
inversion, but in this case the differential diagnosis consists 
in that the prolapsed uterus presents an os into which we can 
pass the sound three or more inches, Avhile the inverted 
uterus presents an oval surface, with no opening in its depend- 
ent portion. 

The tumor is larger in its lower portion in inversion, and 
tapers upwards, while in prolapse the lowest portion is the 
smaller. The uterus, which is inverted after confinement, 
will contract and become much smaller if it remains long 
inverted, though it remains larger than in its normal state — 
i. e.., complete involution does not take place in the inverted 
organ. 

Retention of urine is a symptom in some cases of in- 
version. 

Several eminent physicians, surgeons, and gynaecologists 
have made mistakes in diagnosis in cases of inversion. Dr. 
Emmet* says: "I have myself tightened the chain of an 
ecraseur around the pedicle of a supposed polypus, which 
was attached to the fundus at a, distance of over two and 
one-half inches from the cervix, where on further investiga- 
tion the case proved to be one of inversion. Dr. M. A. 
Petit f had a patient in the hospital at Lyons which six 
experienced surgeons decided had a polypus, Avhich proved 
to be an inverted uterus. Dr. Wm. Hunter tied what he 
thought was a polypus; the woman died, and the tumor was 
found to be an inverted uterus. Dr. Dubois reports two 
cases of inversion which were mistaken for polypi by emi- 
nent surgeons of Paris. Dr. Denman made the same mis- 
take." Drs. Velpeau and Gooch fell into the same error. 
Most of the gentlemen in this country who have made this 

* Emmet's "Diseases of Women," p. 410. 
"("Barnes's "Diseases of Women," p. 627. 



INVERSION OF THE UTERUS. 569 

mistaken diagnosis have kept their own counsels; therefore, 
I mention no names. 

The little effect produced upon some women by inversion 
of the uterus is truly wonderful, while in others there is a 
profound impression made upon the system from shock, like 
that which results from severe traumatic lesions. This 
shock or depression of nerve force, either with or without 
hemorrhage, is sometimes so great as to prove suddenly fatal. 
Even simple depression of the fundus has caused shock from 
which the patient never rallied. 

The symptoms of simple depression are ordinarily pain in 
the part w T ith some hemorrhage from the uterus. As inver- 
sion progresses the pain is more and more intense, and hemor- 
rhage is sometimes profuse, and at other times it is arrested, 
in great part, as the uterine surface is firmly compressed 
against the cervix in its descent through the cervical canal. 
In cases following soon after confinement, the inversion may 
take place suddenly with but a small amount of pain, 
but the shock in these cases is very great. A w T eak pulse, 
clammy skin, cold extremities, nausea, fainting spells, etc., 
are the symptoms most frequently present in cases of sud- 
den and complete inversion, and should cause the physician 
to at once institute a physical examination ; and, if he does 
not feel competent to decide the diagnosis and institute 
prompt and efficient measures of relief, he should call for a 
consultation at once. In complete inversion the uterus is 
found as a tumor in the vagina, or protruding from the os 
vaginam, its size ranging according to the condition of the 
uterus. 

Treatment. 

Until within the last thirty years the replacement of the 
inverted uterus was thought to be impossible after the lapse 
of twelve hours. In 1847, Dr. M'Coy,* of Harrisville, Ohio, 
reported a case he had reduced two days after delivery. In 

*Ajlaier. Jour. Med. Sciences, July, 1847. 



570 EATON ON DISEASES OE WOMEN. 

the same year M. Valentine* succeeded in reducing one of 
sixteen months' standing {Med. Chi. Review, November, 1847). 
Dr. Quackenbush, of Albany, in 1855 f performed the first 
successful operation for chronic inversion in this country, 
though he did not publish the case till 1859. In 1858 Dr. 
J. P. White, of Buffalo, reported a case that he had success- 
fully reduced which had existed for sixteen years. J 

There are three classes of cases with which we are liable 
to meet, and I think it advisable to discuss their treatment 
separately. They are, the recent inversion after delivery ; the 
chronic inversion following delivery, and inversion, either recent 
or chronic, caused by a fibrous polypus. 

In the case of recent inversion, accompanied with faint- 
ness, coldness, hemorrhage, etc., as is usual in cases following 
delivery, the indication is clear to apply warmth to the feet 
and limbs, and give stimulants freely, though not to the 
extent of producing the depression consequent upon excessive 
stimulation. These things can be attended to by the nurse, 
and we should be busy ourselves in compressing and attempt- 
ing to replace the inverted organ. 

In the case of complete inversion immediately following 
confinement, with the placenta still adherent, it is best at 
once to detach it by inserting the fingers between it and the 
uterus, and taking it off as we would an orange peel from an 
orange. Then seize the uterus in its most dependent part 
and compress it upwards, after placing the patient upon her 
side with her hips elevated and her thighs flexed upon the 
abdomen, having the shoulders and head low. In this posi- 
tion, with one limb held up by the nurse, we grasp the 
extruded bleeding mass without fear or hesitation, with both 
hands, and carry it into the vagina; then, with one hand 
grasping the mass, we proceed to carry it upwards by firm, 

* Rankin's Abstract, January, 1848. 

t Reports, New York State Med. Soe'y, 1859. 

X Amer. Jour. Med. Sciences, July, 1858. 



INVERSION OF THE UTERUS. 571 

continuous pressure, compressing the mass all the while with 
the fingers all that we can, at the same time we press upwards 
steadily. 

This effort is to be persevered in till the hand passes 
with the mass up through the os uteri, and still onwards till 
the organ is reinstated. Just before this is accomplished 
the fundus springs into place, leaA r ing the hand free in the 
cavity of the uterus. Do not withdraw the hand at once, 
but retain it there for a time, so that by its presence it may 
stimulate uterine contractions, and we may be sure that with 
the coming on of contractions the inversion does not again 
result. As the uterus contracts around the hand, allow it to 
slip out, or rather be expelled by the uterine contractions. 

Rest, good diet (which, of course, must be mild at first), 
and good air complete the cure, if we wait long enough. Still, 
to hurry convalescence, China, Ars., Nux, Merc, tod., Ars., 
etc., are useful in giving strength to the patient, if used 
according to their homoeopathic indications. 

Ars. Alb. is indicated if there is great prostration with 
nausea, excessive thirst, etc. 

Ars. Ioclid. — Prostration, with arrest of the secretions, 
scanty, dark urine, torpid bowels, loss of appetite, etc. 

China is specially indicated where there has been great 
loss of blood, and there is great weakness, difficult respir- 
ation, feeble pulse, blanched countenance, etc. 

Merc. Sol. — Great weakness, with diarrhoea, impover- 
ished blood, coated tongue, with profuse leucorrhoea. 

Nux Vom. — Prostration, with colicky pains, constipa- 
tion, loss of appetite, general nervousness, exhaustion, trem- 
bling of the limbs, tendency to paralysis, etc. 

Treatment of Chronic Inversion of the Uterus. 

After twenty-four hours the inversion may be considered 
chronic, as the organ has by this time contracted (including 
the cervix) so that it will be impossible to reinstate it with 



572 EATON ON DISEASES OF WOMEN. 

the hands, as just described in treating the recent case, or, 
it is at least impossible to carry the hand within the os and 
complete the reinstatement, though the same principle of treat- 
ment is applicable. 

In the chronic case, especially the one which has existed 
for years, a considerable amount of perseverance is neces- 
sary to accomplish the reposition of the organ. It may take 
repeated trials, aided by ancesthesia. 

Operation to Reinstate the Uterus in Chronic Inversion.— 
In the first place, the boAvels and bladder should be freely 
emptied just previous to the commencement of the attempt 
lo reinstate the organ. The patient should lie upon the side, 
with the hips elevated, the patient's face being turned a lit- 
tle downwards from a side position. This draws the abdom- 
inal viscera away from the pelvis about as well as the knee- 
elbow position, which we can not adopt in this case on 
account of the length of time required in the operation, as 
well as the anaesthetic, which it is advisable to give till 
complete anaesthesia is produced. One limb should be held 
up by an assistant, and the well-oiled hand should grasp the 
tumor and carry it up into the vagina ; still maintaining the 
grasp around the mass, press upwards. 

We now insert a repositor, as represented, with a cup- 
shaped extremity (see Fig. 59), to fit over the inverted fun- 
dus, with a handle about fifteen inches long. This may be 
made of hard rubber or hard wood turned into proper shape, 
or an old-fashioned wood stethoscope may be used, if noth- 
ing better can be conveniently obtained. Dr. White has 
invented a similar apparatus, with a spiral spring attached to 
the handle to press against the body of the operator. (See 
Fig. No. 59.) With this repositor we continue to make 
steady pressure, still maintaining the grasp of the hand 
around the mass as high up as possible. 

Now, expand the thumb and index finger as widely as 
possible, thereby dilating the cervix by pressing against the 



INVERSION OF THE UTERUS. 573 

vaginal wall at its junction with the uterus. Thus, by ex- 
panding the ring through which the fundus has to pass, and 
compressing and forcing up the mass with the hand and the 
elevator we gradually return it within trie os. We should 




Fig. No. 59. — "White's Uterine Repositor. 

now have at hand a smooth, round piece of hard rubber, an 
inch in diameter and about fifteen inches in length. This 
insert into the cervix, and carry the fundus before it till it 
jumps away from the pressure, as it will when almost rein- 
stated. 

After the fundus is within the os, we may sometimes 
complete the operation with a finger carried up into the cer- 
vix ; but often the finger is not long enough, and we can not 
in this way exert the force we desire, and which is found 
to be necessary to complete the turning. Prof. Emmet rec- 
ommends "stitching the os together when the restoration is 
so far accomplished as to get the mass into the os uteri in 
cases which make it desirable to discontinue the anaesthetic 
on account of the length of time consumed in the operation, 
in order to retain what advantage he has gained to start on 



574 EATON ON DISEASES OF WOMEN. 

at his next attempt."* I believe if we have the round ele- 
vator I have just described at hand, of a size just large 
enough to enter the cervical canal, we may complete the op- 
eration at the first trial, as it is getting the fundus up through 
the os, which is usually the most difficult. Dr. Emmet also 
recommends the pressing of two fingers into the depression in 
the uterus from above through the abdominal walls, and press- 
ing it from one side to the other, dilate it, so as to admit of 
the return of the inverted portion. 

It is always desirable when the physician is about to 
attempt to reinstate the chronically inverted uterus, to have 
two or three skillful assistants to relieve him from time to 
time in making the necessary compression upon the mass to 
be returned, as well as to give the anaesthetic. This need 
not be continued all the time; it is better for the patient 
that she come out from its effect for a short time every half 
hour or so. After the reinstatement of the organ the patient 
should be kept in the recumbent position for several days, and 
Secale cor. should be given in large enough quantity to obtain 
its secondary effect (that of inducing contraction). 

If the uterus does not contract when a reasonable quan- 
tity has been given, the finger should be introduced into the 
cervix, and by frictions attempt should be made to excite 
the contraction of the muscular tissues. When this contrac- 
tion commences administer Secale to increase it, giving the 
remedy in twenty-drop doses of the Flu. ext. in warm water 
every twenty minutes till three doses are taken; then wait 
for results. Generally speaking the case is to be now treated 
as an ordinary one of sub-involution. 

Treatment of cases of Inversion caused from Tumors of the 

Uterus. 

In case of inversion from traction upon a tumor attached 
to the fundus, or from the efforts of the uterus to expel it, 

* Emmet's Prin. and Prac. of Gynaecology, p, 426, 7. 



INVERSION OF THE UTERUS. 575 

the first indication is to remove the tumor with the ecraseur, 
if pedunculated, or by enucleation if not pedunculated, and 
proceed to reinstate the organ as in the chronic inversion just 
described, though if there is not much hemorrhage we may 
well wait till the wound caused by the removal of the tumor 
has healed. 

In the recent case following delivery, where there is a 
small intra-mural fibrous tumor in the fundus, I w T ould smear 
the uterus with Ferri persalph., make an incision, remove the 
tumor by enucleation, and proceed to restore the organ by 
taxis, as before described in treating of recent cases of inver- 
sion. Take no sutures in the lips of the incision. 

Other Methods of Operating:. 

Simpson's and Thomas' Method. — " This consists * in making 
an incision through the abdominal wall, so as to get at the 
constricted os uteri from above, and then apply a dilating 
force." Dr. T. Gr. Thomas has been bold enough to put this 
suggestion into successful practice in two cases ; one of these, 
however, resulted fatally, from peritonitis. 

Barnes' Method f — " In 1868, Dr. Barnes having failed 
by ordinary means in the reduction of a case of inversion, 
passed a slip knot of tape over the inverted uterus and drew 
it down. He then made three incisions in the neck of the 
uterus and reinstated the organ by Emmet's plan. No mate- 
rial inconvenience followed." "Drs. Sims and Thomas % have 
put this plan in practice, and it is also recommended by Sir 
James Simpson." 

Watts' Method. ||—" Recently, Dr. Robert Watts, of New 
York, has succeeded in reducing a case of inversion at the 
Roosevelt Hospital, in the following manner: He first drew 
down the uterus, so as to make it protrude partially from 

* Emmet's Principles and Practice of Gynaecology, page 417. 
t Thomas, Diseases of "Women, page 636. 
% Emmet, page 418. 
|| Emmet, page 418. 



576 EA TON ON DISEASES OE WOMEN. 

the vaginal outlet, and then passed two fingers into the rec- 
tum. He then pressed a finger into the depression formed at 
the seat of inversion. Then by means of the hand grasping 
the uterus at the mouth of the vagina, the organ was gradu- 
ally pushed down on to the finger, which, of course, carried 
before it a portion of the anterior rectal wall. He then suc- 
ceeded in getting two fingers through the ring, when it be- 
came sufficiently dilated for the fundus to be pushed up on 
the point of the index finger. Without further difficulty the 
restoration was completed." 

Spontaneous Reduction. — Strange as it may seem, there 
are several cases of spontaneous reduction of the inverted 
uterus reported by Dr. Meigs. I can not understand and 
will not attempt to explain how it is accomplished. Of these 
cases Dr. West remarks : " It is easier to conceive that an 
experienced man should commit an error of diagnosis than to 
understand how any efforts of nature could cure a chronic 
inversion of the womb." 

Amputation of the Inverted Uterus. — Amputation should 
be only recommended when the life of the patient is placed 
in the greatest peril from non-interference. The statistics, 
however, are not so formidable as one might imagine they 
would be. From cases collected by Schroeder* and Scan- 
zonif we have the following results: "Total, sixty -nine am- 
putations, forty-nine recoveries." 

Total. Deaths. 

Simple removal 14 8 

Simple ligature 26 7 

Ligature and removal 29 5 

I will suggest that care be used not to amputate the 
entire organ ; simply cut off the fundus and a part of the 
cervix. The application of a ligature of wire is perhaps 
preferable to any other, tightening it from day to day, and 
removing the greater portion of the tumor with the ecra- 

* Ziemssen's Cyclopaedia, Vol. X, page 221. 
t Emmet's Diseases of Women, page 440. 



IX VERSION OF THE UTERUS. 577 

seur or knife an inch or so from the ligature, after two or 
three days. Dr. Emmet says he would not perform the 
operation under any circumstances, though he has known 
three amputations in the practice of others to recover. 

Anomalous Cases. — Gerard de Beauvais* relates a case 
of recent inversion where death resulted from the strangula- 
tion of the intestine in the uterus. One case related by 
Guyonf had existed twenty years without disturbing the 
health. Dr. Comstock % relates a case of inversion where 
the patient followed the occupation of a dairy-maid. Dr. H. 
Miller. 1 1 of Louisville, Ky., relates a case where the uterus, 
ovaries, and ligaments were torn out by a midwife, and the 
patient recovered. He believes in amputating the womb. 

The Uterus has been Known to Slough Ofe. — E. Cle- 
mensen§ reports a case of complete inversion where the 
uterus separated by gangrene, and the patient recovered. 

Elevation of the Uterus — Upward Displacement. 

Upward displacement is not of so frequent occurrence as 
other varieties. It is produced by hsematometra in cases of 
atresia of the lower portion of the vagina or imperforate 
hymen, and from recto-vaginal hematocele, especially when 
the hcematocele is developed in the cellular tissue below 
Douglas' cul-de-sac. Occasionally peritonseal attachments, oc- 
curring during the latter months of normal gestation, serve to 
retain the uterus in an unnaturally high position in the ab- 
domen. It may also be displaced upwards by tumors in the 
pelvis. 

Treatment. 

The treatment consists in removing the cause produc 
ing it. 

-Acad, de Medecine, 1843. t Jour, de Chir. et de Med., 1861. 

J Boston Med. and Surg. Jour., Vol. VIII. 
II Louisville Med. Jour., 1870. 

§ Barnes' Diseases of Women, page 624. Hospital Tidende, 1865. 

37 



578 EATON ON DISEASES OE WOMEN. 



CHAPTER L. 

RETRO-VERSION AND RETRO-FLEXION OF THE UTERUS. 

Retro-version and retro-flexion are of frequent occurrence, 
though often not recognized by the physician, an error of 
diagnosis being more frequent in retro-flexion than in retro- 
version. This is my own experience, though Prof. Emmet* 
gives only twenty-nine cases of flexures of the body of the 
uterus backwards out of three hundred and forty-five cases 
of displacements. He, however, records one hundred and 
eighty-two cases of flexures of the cervix, without saying 
whether they were backwards or forwards. I infer that he 
found most of these flexures of the cervix backward, which 
would make a total of two hundred and eleven cases of 
backward displacements out of a total of three hundred and 
forty-five cases. This would approximate my own experi- 
ence, though I have kept no exact record of cases (never 
having intended to publish them). 52.75 per cent of all 
flextures he found to be in the cervix, and 47.25 per cent 
in the body of the uterus. I have found that most flexions 
were at the juncture of the body and the cervix. Dr. 
Barnes f says: "Retro-version is not nearly so frequent as 
retro-flexion'' This is also my experience. 

Retroversion and retro-flexion may be congenital or ac- 
quired. By retro-version is meant the tipping backwards 
of the body of the uterus into the hollow of the sacrum, the 
os being carried forwards nearly or quite against the pubis, 
so that the axis of the organ is transverse in the pelvis. 

Retro-flexion signifies the falling backwards of the fundus 

* Emmet's " Diseases of Women," p. 327. 
t Barnes's "Diseases of Women." p. 599. 



Plate XIX 




RETRO-VERSION OF THE UTERUS. 



RETRO- VERSIOX AXD RETRO - FLEXION. 579 

against the rectum, the os remaining in its normal position 
or being carried slightly forwards. In these cases the uterus 
is in a sort of half-moon shape, its concavity looking down- 
wards and backwards. Sometimes the uterus is bent upon 
itself at an almost acute angle, and is still termed retro-flex- 
ion if its concavity is backwards or downwards or both. 
Both in retro-version and retro-flexion the fundus of the 
uterus presses upon the rectum. 

Until the present century little was known of displace- 
ments of the uterus. Simpson and Kiwisch have the honor 
to have instructed the profession more than any others in 
regard to displacements, mainly on account of the facility of 
diagnosis gained by the use of the uterine sound. 

Etiology. 

Retro-version and retro-flexion are the result of similar 
causes, except that the flexure occurs where the uterine tis- 
sues are flabby and relaxed. 

These displacements are usually the result of enlargement 
of the body of the organ, more particularly upon or within its 
posterior wall (due to inflammatory action or the development 
of small tumors in the muscular tissue), and the condition of 
sub-involution, or enlargement in pregnancy, or from the 
growth of polypi within its cavity, conjoined with a relaxed 
condition of the broad ligaments, and also a relaxed condition 
of the peritonaea! folds, which ordinarily support the intestines. 
This relaxation of the supports of the intestines and the broad 
ligaments of the uterus takes place in pregnancy to allow the 
uterus to rise in the abdomen; and when the product of con- 
ception is expelled, and the uterus contracts, these supports 
to the intestines are left weak and of unusual length; and if 
the patient rises too soon after confinement, and the intestines 
press heavily upon the uterus, this weight of intestines, con- 
joined with the sub-involuted condition of the uterus, and the 
relaxed condition of the pelvic connective tissue and vaginal 



580 EATON ON DISEASES OF WOMEN. 

walls, together with the distended condition of the colon from 
accumulation of fecal matter, all tend to produce retro-ver-i 
sion or retro-flexion. I should also mention the distension of 
the bladder as a cause of retro- version. 

In this condition a jolt of the body might bend the fundus 
of the uterus backwards underneath the promontory of the 
sacrum, causing either a case of retro-version or retro-flexion; 
and the pressing downwards of fecal matter in the rectum 
would increase the flexion or version. This possible effect 
of the over-distended bladder should be constantly recol- 
lected. 

The student should constantly bear in mind also that not 
only in retro-version, but especially in retro-flexion, there is 
some prolapse of the entire organ as well. Many cases of 
retro-flexion are overlooked for this reason. 

The physician makes a digital or specular examination, 
and finds the cervix lower in the pelvis than normal, with the 
os directed a little forwards, and concludes there is prolapse 
(as is evident), and so diagnoses the case. He next attempts 
to replace the organ by pressing the os upwards, and inserts 
some kind of a pessary to keep it up. This allows the fundus 
to come downwards more and more, and the patient gets no 
relief. Another and another pessary is tried without avail. 
The patient consults other physicians, who try a wad of cot- 
ton saturated with Glycerine, or make local applications to the 
cervix with a brush (which by this time is much inflamed and 
enlarged). There is probably by this time considerable dis- 
charge from the os, indicating enclo-cervicitis or endo-metritis. 

This recital possibly looks, a little overdrawn to some, 
but it is a true picture of many cases which have come 
under my observation, and if it Avas simply loss of time 
and money to the patient it would not be so bad; but it 
has often broken the constitution of the patient, impaired 
digestion and nutrition, and caused cellulitis, peri-metritis, 
ovaritis, or some ailment which will sooner or later terminate 



Plate XX. 




RETRO-FLEXION OF THE UTERUS. 



RETRO - VERSION AND RETRO- FLEXION. 581 

fatally, all of which might have been avoided by a correct 
diagnosis and proper treatment in the outset. 

It is not often that the unmarried woman has retro-ver- 
sion or retro-flexion, but occasionally cases do occur among 
this class. 

Rectal adhesions are said by Dr. Barnes to be a cause 
of retro-version. These rectal adhesions may result from 
cellulitis, either with or without the occurrence of recto- 
vaginal hematocele. While this hematocele exists it crowds 
the uterus forwards and upwards; but when it is evac- 
uated through ulceration or artificially, the uterus is liable to 
bend backward against the rectum in the space recently 
filled with the hematocele, and there being present some 
inflammatory action, adhesions are liable to occur, and the 
uterus is permanently retro-verted or retro-flexed. 

I must not fail to mention the great influence which gen- 
eral debility has in causing these displacements. General 
debility certainly tends to produce them, and in turn is pro- 
duced by them, and increased by this condition when dis- 
placement already exists. Inattention to the calls of nature, 
leaving the bowels heavy, tends to depress the organ, when 
the accumulation of fecal matter in the rectum presses down 
the fundus. Heavy lifting or a sudden strain, Avhile the 
bladder is distended, may tip the uterus backwards. 

Flexions occurring after the climacteric period are due to 
atrophy and atony of the uterine tissues. They do not. how- 
ever, produce as much effect upon the patient at this period 
as during the time of menstrual activity. 

Diagnosis. 

The patient complains of constipation, frequent desire to 
micturate, pain in the back, nausea upon rising in the morn- 
ing, a sense of weight and bearing down in the pelvis, pain- 
ful menstruation. If married, she also frequently complains 
of dyspareunia. These symptoms will quite clearly indicate 



582 EATON ON DISEASES OF WOMEN. 

a case of retro-version, but the positive diagnosis can only 
be made by a physical examination. In retro-flexion we 
have a similar train of symptoms, with the exception that 
there is not so much vesical irritation, the cervix not being 
carried far enough forwards to irritate the urethra or base 
of the bladder to any great extent. These symptoms may 
come on suddenly after some sudden fall or effort at lifting 
or jumping, constituting an acute case, or they may come on 
gradually, and be of long duration. 

In these latter chronic cases there is usually present a 
considerable leucorrhoeal discharge, often excoriating in char- 
acter, producing vaginitis and vulvitis. The derangement 
of digestion is usually marked, and the patient is troubled 
with tympanites. The patient has usually had much treat- 
ment for prolapsus, and is thoroughly discouraged. Often 
there is a severe cough complained of, frequently caused by 
the derangement of the stomach, produced by the displace- 
ment and not connected with any disease of the lungs more 
than a slight bronchitis, which has resulted from the cough 
rather than being the cause of it. A thorough physical ex- 
amination will clear up the diagnosis, and is, of course, nec- 
essary to rectify the displacement. 

In retro-flexion, a vaginal examination reveals the os in its 
normal position, save that it is carried a little forwards and 
downwards. (I will just here say that the physician should 
have his patient evacuate the bowels and bladder just pre- 
vious to the examination, if possible). If she has recently 
menstruated, and there is no fear of pregnancy in the case, 
we next proceed to introduce the uterine sound, the patient 
lying upon the back with the knees drawn up, and covered 
with a sheet (of course.) We first attempt to pass the in- 
strument with its concavity forwards, as it would need to be 
if the uterus was in its normal position ; in case the instru- 
ment is arrested in its course, we turn it over till its con- 
cavity looks backwards; if, then, it will not advance, we 



RETRO -VERSION AND R ETRO - FLEXION. 583 

should press up the fundus through the posterior wall of the 
vagina or through the rectum with a ringer of the left hand, 
while we still attempt to introduce the sound with the right 
hand. Generally, in retro-flexion the sound passes up about 
an inch in nearly a normal direction. In retro-version, we 
direct the sound backwards from the start. The os being 
rather tightly pressed against the pubis and rather inclined 
upwards, we sometimes have to push up the fundus either 
through the vagina or rectum before we can get the sound to 
enter the cervix. In case the sound enters the fundus while 
directed backwards, it is conclusive proof of the backward 
displacement. 

When we introduce the sound, and it passes readily up 
into the uterus in its normal position, we know that the 
symptoms in the case are due to some other cause than dis- 
placement. If we can detect a globular body posterior to the 
cervix, which we had thought to be the fundus, and which 
we have by the sound found to be something else, we should 
at once try to ascertain what the tumor is. It might be 
impacted feces — the ovary enlarged and displaced — a tumor 
on the posterior wall of the uterus, or it might be a recto- 
vaginal hematocele of small size, or indicate the commence- 
ment of cellulitis. 

The aid of the speculum is not required in the examin- 
ation of cases of displacement. 

In case pregnancy is suspected or known to exist, and 
we have symptoms strongly pointing to retro-version as the 
difficulty, Ave must depend upon the information we may 
gain by digital examination per vaginam and rectum. Gen- 
erally we are aided in the diagnosis by the suddenness of 
the attack, and the enlarged size of the uterus, as well as 
the irritation of the bladder being more severe on account of 
the pressure being greater than in cases where the uterus is 
unimpregnated, owing to the uterus being longer, and conse- 
quently forcing the os harder against the urethra. This is 



584 EATON ON DISEASES OF WOMEN. 

especially the case if the uterus is retro-verted. In case it 
is retro-flexed we have to depend upon rectal examination, 
in connection with the symptoms and the history of the case, 
to make out the diagnosis. 

In some instances adhesions take place in the cervical 
canal at the point of greatest flexure, and in nil cases the 
cavity of the cervix is lessened in size, at the point of flex- 
ure, which in part accounts for the dysmenorrhoea, so gen- 
erally complained of, especially if the flexure is at all 
abrupt. It particularly affects the unmarried and sterile in 
this way. Those who have had children are not so frequently 
troubled with painful menstruation, even though they have 
a retro-flexion of the uterus. 

Various nervous symptoms of a sympathetic character often 
complicate cases of retro-version or retro-flexion. One descrip- 
tion so admirably given by Dr. Barnes * I quote on this point : 
u The nervous system, often so susceptible in women, will 
exhibit the most marked aberrations. The nervous centers 
respond to the slightest impressions. Hysteria breaks out in 
all its manifold eccentricities. Neuralgia appears in one or 
more of its various forms, as sciatica, lumbago, tic- douloureux, 
rheumatism; headaches and a disposition to vertigo or syn- 
cope frequently recur; emotional, moral, and intellectual 
disturbances as manifested in irritability, despondency, melan- 
choly, loss of command over feelings and thoughts are often 
developed. Many of these phenomena may be thus traced to 
bad nutrition; but there is good reason to believe that espe- 
cially the nervous phenomena are more directly induced, or 
are, at any rate, aggravated, by the influence of the displaced 
uterus upon the nervous centers." 

The congested displaced organ is a constant source of ner- 
vous irritation and exhaustion; it is constantly pressing upon 
the sacral plexus; it is constantly sending painful impressions 
to the nervous centers ; constantly using up in a morbid 

* Barnes' Diseases of Women, page 608. 



RE TRO - VERSION AND RETRO- FLEXION. 585 

direction the nerve force which is wanted for the performance 
of healthy function. 

A not uncommon form of nervous disorder, induced by 
retro-version, is severe, almost constant, pain in the lower 
part of the spine ; sometimes most intense in one fixed spot. 

Many such cases have been treated as sufferers from 
spinal disease, and have been confined to the conch, wearing 
various spinal instruments for months and years under the 
erroneous belief that the spinal suffering was primary and 
organic, its sympathetic character not being suspected. With 
or without marked spinal pain, a sense of numbness, and 
want of power, especially of inability to walk, are often com- 
plained of, and tend to confirm the belief in spinal disease. 
Brown Sequard distinctly traced paraplegia to a retro-flexed 
uterus. 

I can well imagine the surprise with which the reference 
of these formidable consequences to retro-flexion of the womb 
will excite in the minds of those physicians who are igno- 
rant of the pathology of the pelvic organs. They perhaps 
will exclaim, " Such are the extravagances of specialists." 
Yet, I would ask, is not the sequence of events as nar- 
rated quite in harmony with sound pathology ? I am very 
sure they are in harmony with accurate clinical obser- 
vation. If this be doubted by those who are ignorant of 
gynaecology, may it not be because they have thought it 
might be possible to study successfully diseases in women, 
whilst omitting to take note of the diseases of those organs 
which make women what they are? The test of treatment 
confirms the conclusion drawn from diagnostic explorations. 
In the great majority of cases the evils enumerated as found 
in association with retro-flexion are relieved and finally re- 
moved when the retro-flexion and its local consequences 
are cured. 

Uterine Changes Caused by Flexion of the Organ. — 
Obstruction to its circulation brings congestion. This leads to 



586 EA TON ON DISEASES OF WOMEN. 

hypertrophy of its walls, especially of the body, the vaginal 
portion often partaking only slightly in this change. 

The obstruction to the escape of menstrual and mucous 
secretions from the cavity of the uterus increases the conges- 
tion, and leads to increased secretion, These being retained 
uterine contractions are excited to expel them, the os inter- 
num being more or less closed, the uterus contracting as a 
sphere upon its contents. There is ? then, in proportion to the 
extent of the obstacle opposed in the os internum, dilating 
force applied to the mouths of the tubes. These gradually 
yield, and a retrograde dilatation of the tubes sometimes will 
follow. 

The dilatation of *the cavity of the retro-flexed uterus is 
always attended by some amount of chronic inflammation of 
its mucous membrane. Perhaps the term inflammation is 
illy chosen ; the condition is rather one of constant engorge- 
ment, leading to rapid shedding of epithelium and increase 
of mucous secretion. 

The retention of the mucus causes uterine colic. A cer- 
tain quantity of mucus must accumulate before the uterus 
becomes so distended, as to excite it to contract. This quantity 
in many Avomen is remarkably definite, taking in some cases 
a week, in others a fortnight, to collect. Why the expulsive 
colic simulating dysmenorrhcea occurs midway between two 
periods, is simply because the uterus being emptied at the 
menstrual epoch, the secretions begin to gather again from 
that time, and cause contractions when it becomes filled up. 
Not seldom a little blood is mixed with the mucus. This is 
not to be interpreted as the result of ovulation, but is simply 
hemorrhagic and the product of engorgement. 

It is a common history we hear from women suffering 
from uterine obstruction, that they have periodical gatherings 
like an abscess in the womb, attended by severe colic and ex- 
pulsive pains, which are relieved by the "bursting" and 
escape of a quantity of discharge. These cases are of the 



RETRO- VERSION AND RETRO- EL EX ION. 587 

kind above described, although they may not exhibit equally 
regular periodicity. 

Treatment. 

There are three classes of cases of retro-version and retro- 
flexion, which require a somewhat different treatment. In 
retro-version we expect to be more successful than in retro- 
flexion. This is due to the flaccid condition of a part or a 
whole of the uterine tissue in most cases of retro-flexion, and 
causes a return of the difficulty more readily. The three 
conditions which require modified treatment are : 

The recent case zuhich is not pregnant, 

The case complicated with pregnancy, and 

The chronic case not pregnant. 

In the recent case of retro-version or retro-flexion (which 
is usually caused by a strain, jolt, or fall) we have little diffi- 
culty in effecting a complete and rapid cure, for in these cases 
the abdominal viscera are not so much displaced, and the 
attachments of the intestines have not given way so much, 
as in chronic cases. We, therefore, need pay but little at- 
tention to lifting up the intestines, and need use no pessaries. 
Ordinarily, when the uterus is reinstated in these cases, it 
stays. 

Operation for Reinstating the Organ. — First, have the 
bowels and bladder evacuated. The patient may then be 
placed upon her left side, with her hips upon a pillow, shoul- 
ders and head low, and the thighs flexed upon the abdomen; 
or she may rest upon her knees and chest, called the knee- 
elbow position. The hips in this position are elevated at an 
angle of about forty-five degrees, and the weight of the 
abdominal viscera draws them away from the pelvis, and 
leaves a space for the uterus to occupy its normal position. 
Either of these positions of the patient is desirable. (I have 
often, however, in recent cases replaced a retro-verted uterus 
with the patient reclining upon the back ; but it is more diffi- 
cult, and I do not recommend it.) 



588 EATON ON DISEASES OF WOMEN. 

I next pass the index finger of the left hand into the vag- 
ina, to ascertain the position of the os, and direct the sound, 
which is to be held in the right hand, with the concavity 
directed backwards as regards the patient. Insert the sound 
gently to the fundus; then withdraw the finger from the 
vagina, and insert the middle finger into the rectum, and press 
the fundus upwards and forwards, at the same time carrying 
the handle of the sound backwards. After carrying the sound 
as far back as the perineum will allow, turn it gently over in 
the fingers, so that its concavity will be forwards ; this move- 
ment lifts the uterus out from the hollow of the sacrum, and 
throws the fundus forwards into its normal position, if we at 
the same time carry the whole organ upwards after we have 
turned the fundus forwards by withdrawing the finger from 
the rectum, and inserting it into the vagina, pressing upwards 
at the same time, with the finger against the os, and the 
sound resting against the interior of the fundus. Or, instead 
of the sound, we may use Elliott's elevator (see chapter on 
Instruments, Plate XIV). 

In using the sound for the purpose of replacement of the 
retro-verted or retro-flexed uterus, as we make the rotary 
motion to change the point of the instrument from looking 
backwards to looking forwards, the movement should be steady 
and firm, but gentle. When the position of the patient is 
favorable, so that we have gravity to assist us, with atmos- 
pheric pressure utilized, by the partial vacuum caused by the 
gravitation of the bowels upwards, and the opportunity given 
the air to enter the vagina during the manipulation for the 
replacement of the uterus, it (the atmospheric pressure) does 
more to correct the partial prolapse than it does to restore the 
retro-version or retro-flexion. The attachment of the vagina 
to the cervix uteri is so near the os uteri, and the posterior 
cul-de-sac of the vagina is so small, that even the hardest 
upward pressure against the fundus of the uterus, if exerted 
through the vaginal wall, will fail, unaided, to restore a retro- 



RETRO -VERSION AXD RETRO-FLEXION. 589 

version or retro-flexion. The atmosphere aids us, then, only 
as it elevates the uterus in the pelvis; it can not change 
the axis of the organ, or rectify a flexion, unaided. 

After the uterus is reinstated the patient should lie as 
quietly, as possible. It is best that the patient be upon her 
bed when the operation is performed. Strictly enforce the 
reclining posture, and direct that a pillow be placed under the 
hips, and that she lie upon her side, using a bed-pan for the 
calls of nature, and not rising to the erect posture for several 
days. This plan may be carried out in some cases, but in 
others it can not be. If we find it is impracticable to restrain 
the patient in the recumbent posture we had better use pre- 
cautions in other ways to prevent a relapse of the displace- 
ment, as I will mention in the treatment of the chronic case 
of retro-version or retro-flexion. (See chapter on Instruments. 
regarding the use of Elliott's uterine elevator, and my im- 
provement of the London abdominal supporter.) 

Treatment of Retro-version or Retro-flexion Complicated with 

Pregrnancy. 

In these cases we are precluded from using a sound or 
uterine elevator passed into the uterine cavity, on account of 
the danger of producing a miscarriage; hence, we must reduce 
the displacement by taxis, aided by gravity and atmospheric 
pressure. 

The patient should, as before, be placed either upon her 
left side. w T ith the hips elevated and thighs drawn up, or in 
the knee-elbow position (after having freely evacuated the 
bladder and rectum). Insert the first two fingers of the right 
hand into the vagina, and press the cervix backwards, while 
we insert one or two fingers of the left hand into the rectum, 
and press against the fundus through the anterior wall of the 
rectum, crowding it upwards and backwards. We, of course, 
have more freedom of motion with the fingers in the vagina 
than with those in the rectum; and we may gain much advan- 



590 EATON ON DISEASES OF WOMEN. 

tage by a sudden backward motion against the cervix when 
the fundus is pressed forwards and upwards as far as we are 
able with the ringer in the rectum. 

Should we for any reason fail by this style of taxis to 
reinstate the uterus, we may with great advantage insert an 
elastic air bag into the rectum, and carry it up with the finger 
so it is just back of the fundus. After it is carried as high 
as possible with the finger in the rectum the bag should be in- 
flated by an assistant, while we give to the cervix the sudden 
backward motion before-mentioned. This will usually prove 
efficient, and the patient should be kept in the reclining pos- 
ture, the same as recommended in the recent variety uncom- 
plicated with pregnancy. After the lapse of two or three 
weeks the liability to relapse is slight, and the patient may be 
allowed to rise and walk about. 

This freedom from liability to relapse is due to the size of 
the womb having increased during the time it was displaced 
and during these weeks of rest, so that if it did have a ten- 
dency to become again displaced backwards, the fundus 
would rest against the promontory of the sacrum and prevent 
a retro-flexion or retro-version. These manipulations, if gentle, 
need not endanger a miscarriage. No pessary is usually re- 
quired in this class of cases,, though it is sometimes desirable 
to wear a nicely adjusted abdominal supporter for a few 
weeks, when the patient commences to go about. 

Treatment of the Chronically Retro-flexed or Retro-verted Uterus. 

In the chronic case of retro-version or retro-flexion, we 
have to contend with a relaxed condition of the supports of 
the intestines and the consequent displacement of them down 
upon the displaced uterus. In connection with this we have 
in some cases attachments formed, more or less strong, be- 
tween the uterus and the cellular tissue situated between the 
vagina and rectum. Conjoined with this we have the relaxed 
condition of the uterine muscular tissue and debility of the 



RETRO- VERSION AND RETRO- FLEXION. 591 

entire system, caused by the pain, the discharges, the inflam- 
mation, indigestion and constipation, so common in these dis- 
placements; hence it is that a very different treatment is 
required in the chronic case from Avhat is efficient in the 
recent one. 

On account of the various difficulties we encounter in the 
treatment of these chronic displacements, we must be upon 
our guard in giving a promise of speedy and certain relief. 

The long time required for the complete cure of this class 
of cases, makes it unwise to compel the continuous resort to 
the recumbent position; hence in the outset we must devise 
means to lift up the abdominal viscera and retain them from 
pressing down upon the uterus, until such time as the attach- 
ments and supports of the intestines become strong. Upon 
our skill in accomplishing this object will largely depend 
our success in the treatment of these displacements. 

Different patients must be treated in different ways. In 
a few cases we may be unable to succeed, but in the great 
majority we may be successful. It is not worth while to 
fritter away valuable time in efforts to cure the inflammation 
in the cellular tissue or the endometrium, or the dyspeptic 
or hysterical symptoms present, till we have adjusted the 
displacement and secured its stability, when in many in- 
stances the sympathetic symptoms leave. 

First, then, let us secure a properly adjusted abdominal 
supporter, and see to it that it acts as a supporter, and not as 
an abdominal compressor. This may usually be accomplished 
with my improved London supporter made by Wocher & Son, 
Cincinnati (see chapter on Instruments), or by means of the 
silk elastic abdominal band. Sometimes in using either of these 
it is necessary to apply a pad of cloth under them against 
the lower abdomen to get sufficient pressure, to lift the vis= 
cera upwards when the band is tightened. The upper part 
of the band must be left loose so that the abdomen may rise 
upwards and forwards, and rest upon the supporter. When 



592 EATON ON DISEASES OF WOMEN. 

this is accomplished we have caused a partial vacuum in the 
lower abdomen, and the replacement of the uterus and its 
maintenance in situ is made comparatively easy. 

We may then proceed to reinstate the uterus in the same 
manner as in the recent case, using taxis, the sound or uter- 
ine elevator of Elliott in the uterus and the air hag of Gariel 
in the rectum. This air bag or elastic pessary is made of 
soft elastic rubber of various sizes and shapes, with a tube 
attachment about eighteen inches long, by means of which 
the bag is to be inflated, after being introduced in a collapsed 
state. This throws the fundus forwards, as explained before 
in the treatment of the recent case of retro-version or retro- 
flexion. When attachments have formed of so strong a char- 
acter that we are unable to restore the organ by using gentle 
force, we must abandon the attempt and use such means and 
remedies as the most urgent symptoms demand. 

After succeeding in the replacement of the organ I prefer 
to apply a wad of cotton saturated with Hydrastis and Gly- 
cerine to the cervix, and beneath it insert the elastic pessary 
just mentioned. This is especially necessary if our patient 
is compelled to at once assume the erect posture, and we are 
not sure of the perfect action of the abdominal supporter; 
but in case the patient can remain in the reclining posture 
for two or three weeks, we can dispense with the pessary 
in toto ; and we can lay aside the abdominal supporter also 
till the patient is about to rise. Put it on before she rises, 
whenever that is, whether it is one day, a week, or a month 
after the operation. Keep the hips elevated. Daily, or twice 
a day, have the round glass speculum introduced into the 
vagina, and allow it to remain for an hour or so, to allow of 
the free ingress of atmospheric air. Give the patient good 
air to breathe and good food to eat, keeping the whole body 
warm. 

Examine once in two or three days per vaginam to see 
that the os is in position. If found too far forwards insert the 



RETRO - VERSION AND RETRO - FLEXION. 593 

sound, and ascertain if there is a partial return of the dis- 
placement; if so, rectify it at once. The cotton wad may 
well be removed and renewed for several days, once in 
twenty -four hours, or oftener, if the discharge is profuse. 
Nux is a remedy almost universally demanded in these cases, 
though when there is any tendency to inflammatory action or 
high nervous excitement Aconite is indicated, and Hi/osc?/amus, 
Verat. vir., or Gelsemmiim if the symptoms are hysterical. 

Electricity in gentle current passed through the abdomen 
and uterus is of some service. Tepid bathing of the hips, 
back, and loins, with warm vaginal injections, are useful. 

Bell, is indicated when there is a tendency to stupor, 
with a flushed face and bearing down pain in the pelvis and 
abdomen. 

Cal. Carb. 9 for a sense of exhaustion and debility, im- 
proved after rest. 

Rhus Tox. 9 for the tired, sore feeling not relieved by 
rest, tenderness of the muscles, etc. 

Pessaries in the Treatment of Retro-version and Retro-flexion. 

In general terms, I can say of pessaries in the treatment 
of these displacements, that as they have been used they 
have proven themselves a delusion, and have doubtless clone 
much more harm than good. I am gratified to see that Pro- 
fessor Emmet,* of New York, speaks emphatically against the 
intro-uterine stem pessary, and I hope that erelong the pro- 
fession will abandon many other forms now in use. Dr. E. 
says : " Unfortunately members of the profession are fre- 
quently advocating the use of the stem pessary, regardless 
of the experience of those who have gone before them, until 
they, in turn, have to learn that they have not been the wiser 
in their day. 

"As soon as the true condition comes to be appreciated, 
the use of the intra-uterine stem will be abandoned as a 

* Emmet's Prin. and Prac. of Gynaecology, page 352. 
38 



594 EATON ON DISEASES OF WOMEN. 

most irrational instrument. Experience will at last teach 
every one that no permanent benefit is ever derived from 
its use, that no degree of tolerance is ever established, but 
that sooner or later in almost every case mischief will re- 
sult. I have long taught that its use in a flexure would be 
as irrational as the introduction of a straight steel sound 
into the urethra for the relief of an existing chordee; the 
penis might be straightened by force, but the cause of the 
difficulty would certainly not be removed. 

"Were we to straighten out a flexure of the cervix by 
means of an intra-uterine stem, the end of the instrument 
Avould make continued pressure on the posterior walls of the 
vagina, on account of the want of space in the canal. So 
much disturbance, in American women at least, would be 
excited in the vagina and uterus, that inflammation would 
certainly become established if its use were persevered in. 
Then, as soon as the instrument is removed^ the neck will 
return to its original condition. 

" If this instrument be employed with a flexure of the 
body of the uterus, the disturbance is likely to be even 
more marked. A condition exists which so closely resembles 
an inflammatory one, that the slightest provocation is often 
sufficient to establish cellulitis, and even general peritonitis. 

"Whenever, by sanction of a merciful Providence, the 
stem has been tolerated for a time, even in this condition, 
no more progress will have been made toward removing the 
existing cause of the flexure than would be accomplished 
by the sound in a case of chordee. Moreover, were its use 
entirely successful, so far that the canal remained perfectly 
straight and patulous afterwards, the cause of the flexure 
would remain, and the pain of menstruation would in all 
probability be increased in consequence of such disturbance." 

My own opinion is, that the use of nearly all vaginal 
pessaries is open to nearly the same objection. This is em- 
phatically true where no effort is made to take off from the 



RETRO - VERSION AXD RETRO- FLEXTOX. 595 

uterus the superincumbent weight of the displaced abdom- 
inal viscera, and the uterus is pressed from above against 
the hard substance of the pessary in the vagina. 

There are two ways in which vaginal pessaries have been 
made useful. The ring pessary has allowed the more free 
ingress of atmospheric air. It acts as a vaginal dilator. It 
can never act as a uterine supporter directly, for, if small 
enough to just reach around the cervix, it will fall to the 
lower portion of the vagina ; if large enough to distend the 
vagina, the uterus might partially prolapse through it, and 
become constricted. This condition is bound to occur when 
the weight is considerable upon the uterus, and the patient 
is allowed to go about. The soft rubber disk pessary of 
soft rubber inflated is the best of this form, if one must be 
used. The inflatable gum-elastic bag, egg-shaped and in- 
flated with a tube from the outside of the patient after the 
bag has been introduced and well pressed up anterior to the 
cervix and inflated while this pressure is maintained, fills 
the vagina, presses the cervix backwards, and tends greatly 
to prevent a recurrence of retro-flexion or retro-version when 
we conjoin with its use the abdominal supporter, or confine 
our patient to the recumbent posture. 

Still, even these soft pessaries are objectionable if con- 
tinued long, in that they by their presence obstruct the cir- 
culation, and retain offensive and irritating discharges. I 
only use them till I can get the abdominal support properly 
applied, and the patient instructed as to its proper use, or in 
case the patient shows no judgment and will not co-operate 
in the proper treatment. In these cases we must personally 
remove, cleanse, and replace it every day or two. If we 
trust the patient to do this, she will be as likely to get the 
pessary behind as in front of the cervix, and, consequently, 
rather do harm than good with its use. 

The cup pessary, which sustains the uterus in a cup, which 
is attached to a steel bar, curved properly and attached in 



596 EATON ON DISEASES OF WOMEN. 

front to a band around the waist, can be worn by but few, 
and is very liable to produce inflammation of the cervix; 
still may be required in obstinate cases in old women, (See 
Plate VII.) 

Incisions of the Cervical Canal in cases of Flexion. — 
This operation was first proposed by Prof. Simpson, of 
Edinburgh. But I presume that Dr. Sims, of New York, has 
most frequently performed it. It is one I have never found 
necessary to adopt in the treatment of flexions of the cervix, 
or any part of the uterus. There may, however, occasion- 
ally be found a case where a slight incision at the point 
of acute flexure might be of service in allowing the more 
easy introduction of a sound or uterine elevator, and facilitate 
the introduction of the sponge tent, if its use should be nec- 
essary, to dilate the stricture of the cervical canal at this 
point. Prof. Emmet* says: " Since the practice of indis- 
criminate division of the cervix was first introduced by Prof. 
Simpson, more malpractice has been perpetuated throughout 
the world in the name of this simple operation than from 
any other procedure known to the profession." Prof. Emmet 
has, however, performed the operation, which he does by in- 
cising the entire cervical tissue through posteriorly. Any 
uterus into the cervix of which we can readily introduce either 
a hysterotome or scissors, does not need incising. If there is 
any canal at all it can be found with a small uterine probe, 
and its size gradually increased by dilatation. If there is no 
opening the case is one of atresia, and must be treated 
accordingly. I will, therefore, give no directions for the 
performance of an operation I do not believe is absolutely 
demanded. 

The use of Sponge Tents in Flexions. — Sponge tents may 
be demanded to dilate a stricture of the cervical canal 
caused from a flexure, as well as to facilitate the use of the 
uterine sound or elevator. They in a slight measure may 

* Emmet's Diseases of Women, page 351. 



RETRO- VERS10X AND RETRO- FLEXION. 597 

aid in straightening the flexed cervical canal; at any 
rate, they help to make the canal larger, and, consequently, 
prevent much of the dysmenorrhea caused by flexions with a 
contracted cervical canal. In using the sponge tent the 
applicator is desirable. (See Fig. No. 60.) 

This sponge tent applicator has a spring slide upon it, so 
that by pressing upon this spring we can withdraw the in- 
strument without mak- 
ing any traction upon ^|jglP^ ■-■■■ — ^SMr. 
the sponge itself, as the FlG Xo eo.— emmet's sponge tent applicator. 
spring slide presses against the sponge, and tends to press 
the tent further in, rather than to withdraw it, when we 
remove the applicator. 

The sponge selected must be of the smallest size and curved 
to correspond to the flexure, as nearly as possible. Turn 
the concavity of the sponge backwards. Press the sponge 
well into the cervix, and retain it in position with the appli- 
cator for ten or fifteen minutes, to give the sponge time to 
get moist and a little expanded. Allow it to remain from 
twelve to twenty-four hours, and upon its removal insert a 
second, larger one with a sharp point, unless we find the 
first has dilated the cervical canal sufficiently to allow of the 
introduction of the sound into the body of the uterus. If so, 
the use of the tent maybe abandoned. In the use of the tent 
here, as in other cases, it should be dipped into carbolized 
Glycerine before it is inserted. 



598 EATON ON DISEASES OF WOMEN. 



CHAPTER LI. 

ANTE-VERSION AND ANTE- FLEXION OF THE UTERUS. 

Ante- version is the term given to the position of the 
uterus when displaced nearly transversely in the pelvis, the 
os uteri looking backwards towards the sacrum, and the fun- 
dus directed towards the pubis, or directly against it and the 
urethra and bladder. In ante-version the fundus is moved 
downwards and forwards, and the os carried backwards, or 
backwards and upwards. 

If the case is one of ante-flexion we find the os uteri in a 
normal position, or a little backwards and downwards, the 
fundus pressing forwards and bent upon the cervix, and, con- 
sequently, pressing upon the bladder and carrying it down- 
wards, as well as causing some prolapse of the anterior wall 
of the vagina. 

Some authors contend that ante-flexion and ante-version of 
the uterus do not and can not exist. In this position I am sure 
they are much mistaken, as these displacements are of frequent 
occurrence. 'T is true, the normal position of the uterus is 
with the fundus slightly inclined forwards. But normally it 
does not press against the bladder with any considerable 
force, and does not prolapse the anterior wall of the vagina. 
Sometimes in ante-flexion the amount of prolapse is very con- 
siderable, pressing the cervix down against the posterior por- 
tion of the floor of the pelvis; at other times, the flexure is 
quite abrupt, and not accompanied with much prolapse. The 
most common seat of an ante-flexion is at the juncture of the 
cervix with the fundus. 

The effect of ante-version is to cause sterility, dysmenor- 
rhcea, and dyspareunia. According to the best and most com- 



Plate XXI. 




ANTE-VERSION OF THE UTERUS. 



Plate XXII. 




ANTE-FLEXION OF THE UTERUS. 



ANTE-VERSION AND ANTE - FLEXION. 599 

plete statistics I can gather, over fifty per cent of sterile 
women have ante-version or ante-flexion of the uterus. My 
experience is that in ante-flexion the angle of flexure is more 
acute in the majority of cases than in retro-flexion. 

Etiology. 

The principal causes of ante-version and ante-flexion are 
the weight of the intestines resting too heavily upon the 
uterus, owing to the relaxed condition of their supports, con- 
joined with lifting or a sudden jolt or fall; the thickening 
of the anterior % wall of the fundus from inflammation, or the 
presence of tumors in the anterior wall; the use of corsets 
tightly laced; the weight of clothing supported by a band 
around the waist, pressing the intestines down upon the 
uterus; ante-version being produced when the uterine tissues 
are firm, and ante-flexion when they are relaxed. If the 
uterus maintained its normal height in the pelvis, and was 
ante-flexed upon the bladder, the filling of the bladder would 
temporarily replace the uterus; but it is found by experience 
that instead of the bladder becoming filled, and replacing the 
ante-flexion, the ante-flexion prevents the filling of the blad- 
der, and its walls are so compressed and irritated that the 
bladder will contain but little before it contracts to expel 
what is in it. 

Faulty nutrition in the anterior portion of the cervical 
juncture with the fundus has been thought to be a cause of 
ante-version, but the theory is hard of demonstration. The 
condition of sub-involution and pregnancy may also tend to 
cause ante-version and ante-flexion. 

Diagnosis. 

The symptoms which may lead us to think of anterior dis- 
placement of the uterus are more especially, irritation of the 
bladder, frequent and painful micturition, dysmenorrhoea with 
leucorrhoea, dyspareunia, etc., in connection with the ordinary 
symptoms of displacements, both general and local. Frequent 



600 EATON ON DISEASES OF WOMEN. v 

and painful micturition may, however, be due to retro-version 
or inflammation of the bladder. Hence, it will require a 
physical examination per vaginam to determine the exact 
nature of the displacement. 

In ante-version we discover by digital examination that 
the os uteri is displaced backwards, and looking towards the 
hollow of the sacrum. The fundus is felt (through the ante- 
rior vaginal wall) in the upper part of the vagina as a globular 
or pear-shaped body, generally pressing the urethra hard 
against the pubis. The axis of the vagina is changed from 
an oblique upward direction to \>ne almost transverse from 
before backwards. 

In ante-flexion we find the os generally somew T hat lower 
in the vagina than normal, pointing downwards, but situated 
a little further backwards than in the natural state. The 
fundus of the uterus may be felt apparently occupying a 
transverse position at nearly a right angle with the cervix. 
To positively determine the uterus is ante-flexed, it is nec- 
essary to introduce the uterine sound (which can be done if 
there if no possibility of pregnancy). If the sound enters 
the body of the uterus with the point only slightly inclined 
forwards from the direction necessarily given it in its intro- 
duction into the cervical canal, we may know that the bunch 
which we first thought to be the fundus is a tumor in the 
anterior wall of the fundus, an enlarged and displaced ovary, 
an induration resulting from cellulitis, or a large cystic cal- 
culus, and not a case of ante-flexion at all. But should we 
find that the sound is arrested when inserted into the cervix 
about an inch, and we have to turn it abruptly forwards in 
order to enter the cavity of the body of the uterus, we may 
know the case is one of ante-flexion. 

Treatment. 

The first object to accomplish in the treatment of ante- 
version or ante-flexion is to take off from the uterus the 



ANTE-VERSION AND ANTE- FLEXION. 601 

weight of intestines pressing upon it. This may be clone by 
placing the patient upon her back or side, with her hips ele- 
vated and the shoulders low. We may next proceed to cor- 
rect the displacement. 

If it be ante-version, we may attempt to pass one or two 
fingers behind the os uteri and draw the cervix forwards. 
If we can not do this readily, we may hook the point of the 
curved uterine sound into the os, guiding the instrument by 
the fingers already in the vagina, and as we draw the cervix 
forwards allow the sound to ascend in the cervical canal, and 
proceed in this way till the uterus is turned and lifted into 
place. We now withdraw the sound and insert into the vag- 
ina a common glass speculum of suitable size so as not to dis- 
tend the vagina so much as to be painful, and allow it to remain 
for several hours to admit the atmosphere freely ; or a watch 
spring ring pessary may be inserted to accomplish the same 
object. The patient should be much of the time with the 
knees drawn up and separated. The recumbent position on 
the back must be maintained for some time, or a nicely ad- 
justed abdominal supporter may be applied, and the patient 
be allowed to rise. 

In ante-flexion, after we have introduced the sound into 
the uterus we turn its point backwards gently, to lift up the 
fundus, or use the uterine elevator for the same purpose. 
After it is replaced, we may treat the case similarly to the 
one affected with ante-version, which has been replaced. 
The passing of the electrical current through the uterus, 
using the finger for an electrode, while applying it to the 
cervix, is an efficient means of strengthening the relaxed 
tissues in these cases. 

In those cases which are continually relapsing, it is nec- 
essary sometimes to introduce the soft rubber pessary pos- 
terior to the os uteri, and inflate it, and remove and replace 
it every few days for some time, still using the abdominal 
supporter and such remedies as the case seems to demand. I 



602 EA TON ON DISEASES OE WOMEN. 

much prefer, however, to entirely dispense ivith all vaginal pes- 
saries, and I have found that we can do so in most cases 
where we have an intelligent patient who will co-operate in 
the treatment, excepting in a few cases where adhesions 
have formed which require some regular, even force to break 
up and stretch, which may sometimes be done when they 
are not very firm. 

Much care and attention, as well as perseverance, is requi- 
site in these cases, in keeping the organ in situ, and in keeping 
it from being pressed upon by the intestines, and allowing a 
free ingress of the atmosphere into the vagina. Remedies must 
not be overlooked. There is very often a condition of con- 
gestion of the parts in these cases which gives rise to the 
feeling of tenderness, weight, and bearing down sensations 
which indicate Bell, as the remedy; the pain in the small 
of the back and temples indicates the need of Nux.; pain 
in the ovarian region indicates Cimicif.; sharp, cutting pains 
anywhere, Bry. ; a twisting, boring pain in the bowels around 
the navel, Colocynthis. Secale, Canthar., Cal. carl., Cubebs, 
Sulph., Rhus, Puis., etc., should also be studied, as they are 
sometimes indicated in these cases. 

Sponge Tents. — The need for the use of sponge tents may 
arise in cases of ante-flexion as in retro-flexion, to dilate the 
strictured uterine canal, and relieve dysmenorrhoea. They or 
bougies may be* used to establish the canal of proper size. 

Rest, proper diet, and good air, bathing, etc., are never 
to be forgotten. 

The Speculum. — This instrument is not needed either in 
the diagnosis or treatment of these displacements. 

Pessaries. — Pessaries have been the bane of the pro- 
fession, and the sooner the whole batch of hard pessaries are 
destroyed the better for our own reputation and the comfort 
of our patients. How many ulcerations, fistulse, and inflam- 
mations they have produced the judgment day can only 
reveal. They are to be placed with caustics, venesection, the. 



LATERAL DISPLACEMENTS. 603 

actual cautery, indiscriminate incisions of the cervix, and the 
like, and be condemned together. The cases benefited, do 
not equal those injured by them. 

Warm Vaginal Injections. — Injections of warm water 
given in the way of a douche, are often beneficial in those 
cases where there is a supersensitive condition of the pelvic 
viscera. They may be used once or twice a day for a week 
or two if necessary. Astringents and medicated washes are not 
needed, and often do harm. The warm hip bath, used with 
judgment and moderation, is often of service. 

Lateral Displacements. 

Lateral displacements, existing uncomplicated with other 
disease, are seldom found. They can scarcely occur, except 
when there is disease of one of the broad ligaments, adhe- 
sions after cellulitis, a tumor in the side of the fundus, or 
disease of the ovary. As displacements they deserve no 
more than a passing notice. The difficulty which causes 
them, being of so much greater importance, needs the special 
treatment. When, however, Ave find a case of lateral dis- 
placement, Ave should consider the causes producing it. 

Diagnosis. 

Physical examination is always requisite to diagnose a 
case of lateral displacement. As the fundus would not press 
upon any important organ or A'iscera in this displacement the 
symptoms are not as marked as in anterior or posterior dis- 
placements ; still the difficulty Avhich causes the displacements 
may give rise to marked symptoms peculiar to uterine dis- 
ease. By making a digital examination per vaginam Ave 
find the os directed toAvards one side of the pelvis, and 
by introducing a sound into the cervical canal up to the 
fundus, we find it inclining toAvards the opposite side. This 
determines the existence of lateral displacement, but much 
more careful examination is necessary to determine the 



604 EATON ON DISEASES OF WOMEN. 

causes of the displacement. It is unnecessary to go over 
them all here; search should be made in the diagnosis of 
ovarian tumors, fibroma of the uterus, pelvic cellulitis, hemat- 
ocele, etc., for the symptoms which indicate the difficulties 
named. 

Etiology. 

The existence of disease of one of the broad ligaments 
may draw the uterus to one side. The wearing of badly 
adjusted pessaries, thickening of the walls of one side of the 
uterus from inflammation, or the development of a tumor 
in the walls of one side of the organ may cause this dis- 
placement. 

To these causes may be added faulty nutrition and con- 
genital malformation. The development of a small tumor of 
the ovary, or a fibroma in the side of the uterine walls, would 
drag the fundus towards the affected side, while the large 
tumor in these localities would press the fundus to the oppo- 
site side of the pelvis. Adhesions formed after cellulitis will 
also tend to cause a lateral displacement of the uterus. 

Treatment. 

The treatment of lateral displacements must mainly con- 
sist in the removal of the causes which produce them. No 
special treatment as displacements is required — the main ob- 
ject of calling attention to them being to recognize the fact 
of their possible existence, and suggest what they may indi- 
cate as regards other ailments, thereby aiding in the diagnosis 
of the prime and main difficulty. Attempts to replace and 
retain in situ a lateral displacement without removing the 
cause would simply be lost time, and would expose the 
ignorance of the physician, as well as possibly be injurious 
to the patient. For if w-e carefully note the causes we will 
see that most of them are beyond our control; and the 
others require treatment peculiar to themselves. 



Plate XXIII 




PROLAPSE OF THE UTERUS AGAINST THE PERINEUM. 



PROLAPSUS UTERI AXD PROCIDENTIA. 605 



CHAPTER LII. 

PROLAPSUS UTERI AXD PROCIDENTIA. 

These terms are used to designate downward displacement 
of the uterus, prolapse being applied to the downward dis- 
placement of the womb while it is still within the pelvis 
(see Plates XXIII and XXIV), and procidentia when the 
organ is so much displaced as to appear external to the os 
vaginam. (See Plates XXV and XXVI.) 

Prolapse may exist in various stages, from the slight 
downward displacement to the extent of resting against the 
perineum. 

Procidentia is called partial when a small portion of the 
cervix appears in view between the labia; and complete 
when the whole organ is external to the os vaginam (Plate 
XXVII). 

To whatever extent the displacement exists the bladder, 
ovaries, Fallopian tubes, and small intestines are also dis- 
placed downwards in similar proportion; and I may say the 
vaginal walls, and in some instances the rectum and lower 
portion of the colon also, are displaced. 

The sufferings which women endure from prolapsus uteri 
and procidentia are very great, and the effect upon the gen- 
eral health is sometimes disastrous. At other times we meet 
with cases where the system seems to become tolerant of the 
displacement, and very little effect is produced upon the 
general health of the patient. I have seen women who had 
been about their work for years with the uterus dangling 
between the limbs, or retained in the vagina with a T band- 
age, and complaining very little of the displacement. Many 
women suffer from partial prolapse when their difficulty is 



606 EATON ON DISEASES OF WOMEN. 

not discovered, even after their physician has made a vaginal 
examination (the patient being in the reclining posture). 

The patient should stand during the examination, and the 
physician be well experienced, or error of diagnosis may 
result. 

Htiology and Pathology. 

Upon this topic I must differ in a measure from all who 
have written on this subject, so far as I am aware. I do 
this with some reluctance, although I believe I am right, for 
I well know the slowness with which the profession adopts a 
new idea in pathology or etiology. 

Before offering my own ideas I will quote from the most 
recent writers upon the subject. Dr. Barnes* says: "The 
leading fact in the history of prolapse is that of imperfect 
involution after labor. If this great fact be kept steadily in 
mind, and the lessons in practice which it dictates be carried 
out, many cases of prolapse will be prevented altogether, and 
many more will be arrested in their early and curable stages." 

Dr. Emmet f says: "The immediate causes of prolapse 
are threefold — either some growth above the uterus crowds 
it downward, or there is an increase of weight in the uterus 
itself, or there is a want of proper support below. The first 
step in the process is usually to be traced directly to the 
absence of support for the vaginal walls at the outlet of the 
passage, from which a further prolapse is soon induced by 
the increase in weight of the oman, resulting from its mal- 
position." 

" To whatever cause the increase in size and weight of the 
uterus may be due, the organ will settle into the pelvis just 
in proportion to the additional burden " (evidently meaning 
the weight of the uterus). 

Now, that prolapse is caused almost entirely by sub-invo- 
lution of the uterus after labor is disproven, from the fact 

""•Barnes's " Diseases of Women," page 541. 
t Emmet on "Diseases of "Women," p. 366. 



Plate XXIV 




PROLAPSE OF THE UTERUS. 



PROLAPSUS UTERI AND PROCIDENTIA. 007 

that very many women who have never been pregnant suffer 
from this displacement. This is particularly the case with 
girls and young women who are employed as clerks in stores, 
or as teachers, or in any employment where they stand for 
hours at a time. Domestics do not suffer as much, for the 
reason that they are moving about and change their position 
often; they walk, sit, or stoop over, at short intervals, and the 
weight of the abdominal viscera does not press clown into 
the pelvis so directly and continuously as when standing 
erect and nearly still. These women do not as a rule enter 
a hospital, and it may be due to the fact that married 
women among the poorest class more frequently are found 
in hospitals that the gentlemen quoted have arrived at the 
conclusions which they have. 

Dr. Emmet's suggestion of want of support at the vaginal 
orifice being a cause of prolapse of the uterus, would inti- 
mate that which we find he afterwards teaches, that lacera- 
tions of the perineum are one of the most common causes of 
prolapse; in fact, he says (page 367), "that in practice we 
will have to deal with childbirth as the most common of all 
causes in producing procidentia, and in all these cases the 
perineum will be found extensively lacerated." 

It is true that, in many cases in which there is procidentia, 
there is a ruptured perineum; but I deny that the ruptured 
perineum is the main cause of the procidentia. I am of the 
opinion that other and more philosophical reasons can be 
assigned. 

The floor of the pelvis (the perineum) when intact would 
in a measure resist the further descent of the uterus when it 
had become prolapsed enough so that the os rested upon it 
(see Plate XXIII). The perineum then conjoined with a 
contracted os vaginam (which would indicate a long peri- 
neum) would offer some considerable resistance to complete 
procidentia. So would a T bandage if well applied ; but the 
absence of a T bandage would hardly be given as a cause of 



608 . EA TON ON DISEASES OF WOMEN. 

procidentia. Normally the perineum is no more a support of 
the uterus than is a T bandage. The uterus in its natural 
position is about four inches above the perineum, at the top 
of the vaginal cavity ; the vaginal walls are loose and flabby, 
distensible with the slightest force. If the vaginal walls 
stood up like pieces of paste-board, and rested upon the peri- 
neum, the taking away of their support might allow of the 
prolapse of whatever rested upon them; but such is not 
their nature. The vagina is retained in place by means of its 
attachment to the cervix uteri above, and to the cellular tis- 
sue on its sides, which cellular tissue is attached to the 
rectum, bladder and walls of the pelvis. Separate it from the 
attachments I have named, and it will drop down at once to 
the vaginal outlet (when the subject is placed erect). 

In so far as the attachment of the vagina to the cellular 
tissue and uterus is firm and normal, it holds the vagina in 
situ, if there is no abnormal weight in or upon it. But, we 
think, the uterus is sustained mainly by the folds of perito- 
naeum constituting the broad ligaments, the cellular tissue 
surrounding it and the vagina, and by atmospheric pressure 
coming in through the vagina. 

Heavy lifting, tight lacing, forcing the intestines down 
upon the uterus by straining in labor or at stool, and stretch- 
ing and weakening the attachments of the intestines serve to 
produce prolapse directly. 

The conditions present after confinement are enlargement 
of the uterus, it is true ; sometimes a condition of sub-involu- 
tion is present for a long time, but it does not necessarily 
produce prolapse or procidentia, as I have seen hundreds of 
cases Avhere there was sub-involution of the uterus which had 
been present for years, and complicated with endo-metritis 
to the extent of causing much suffering, and still there was 
little or no prolapse at all. 

These cases showed an enlargement of the uterus to the 
extent of measuring from three and a half to four inches in 



Plate XXV. 




PARTIAL PROCIDENTIA UTERI. 



Plate XXVI 




PROCIDENTIA, WITH ELONGATION OF THE CERVIX UTERI. 



PROLAPSUS UTERI AND PROCIDENTIA. 609 

the uterine cavity, as indicated by the uterine sound. Why 
did they not have prolapse? They have weight enough in 
the uterus and often a lacerated perineum. I answer, they 
did not have prolapse, because their intestinal supports 
were firm and normal, and the broad ligaments were not 
relaxed, the cellular tissue around the vagina was normal, 
and the uterus had no superincumbent unnatural weight to 
support. 

Every woman is more liable after confinement than be- 
fore to have prolapse, it is true ; but why ? Not because of 
the sub-involution of the uterus, for very few women have a 
complete and perfect involution of the uterus in the ten days 
they commonly maintain the recumbent position, and if en- 
largement of the uterus was the cause of prolapse, all 
should have it. 

Again, in the growth of uterine polypi and intra-mural 
fibrous tumors of the uterus, do we find the uterus pro- 
lapsed ? Seldom, if ever. Why is this ? The weight of the 
organ is certainly as great, or greater, than in most cases of 
sub-involution. I have discussed this point at some length 
under Displacements (in general), but I deem the subject 
of sufficient importance to demand attention in this connec- 
tion also. 

In gestation, during the last months, the intestines are 
crowded upwards by the large size of the gravid uterus ; their 
attachments become weakened and stretched, the broad liga- 
ments of the uterus also relax. Now, after the expulsion 
of the contents of the uterus in labor, the intestines will 
press heavily upon the uterus, on account of the relaxed 
condition of the mesentery. If the erect posture should be 
at once taken, the broad ligaments being relaxed, they offer 
no resistance, and downwards the uterus is pressed, dragging 
with it the upper portion of the vagina ; and if the uterus 
retroverts in its downward way, the cervix may emerge from 
the vagina, and if the pressure is sufficient the procidentia 

39 



610 EATON ON DISEASES OF WOMEN. 

may become complete, for the vagina is always dilatable if 
not already relaxed, and the uterus may become completely 
expelled from the vagina, although there is no laceration of 
the perineum. 

If there was no perineum, and the patient did not wear 
a T bandage, of course, it would come out a little easier than 
if they were there to offer resistance. Hence, we have to ac- 
knowledge that the laceration of the perineum in small part 
allows of complete procidentia, but we do not concede that 
it is in any way concerned in causing or allowing of pro- 
lapse. Sub-involution does not in itself and alone cause 
prolapse, we think ; but accompanying some cases is a con- 
dition of the broad ligaments and abdominal organs caused 
from inflammation (which often is the cause also of the sub- 
involution), which tends to produce a downward displace- 
ment. The sub-involuted condition may co-exist with pro- 
lapse, but I deny its being the principal cause of it. 

In these cases where lacerations occur, there have usually 
been present the most intense expulsive pains. These 
severe bearing clown efforts tend to displace all the abdom- 
inal viscera downwards in any case of labor, and where they 
are strong enough to cause a laceration of the perineum, or 
to exhaust the patient, so that forceps have to be used, the 
downward displacement of the intestines must be consider- 
able, on account of the straining and the atonic condition 
produced by the general exhaustion incident to labor. Strain- 
ing at stool from constipation tends to produce prolapse, 
which may come on gradually, forcing down the intestines 
upon the uterus and weakening the broad ligaments. 

The straining from efforts of the uterus and voluntary 
muscles of the abdomen to expel a polypus from the uterus 
may also in the same way cause prolapse. Tight lacing of 
the chest and upper part of the abdomen tends to force the 
abdominal organs downwards upon the uterus, and produce 
prolapse. Dr. Emmet says, page 368 : " In early life, even 



Plate XXVII 




COMPLETE PROCIDENTIA UTERI. 



PROLAPSUS UTERI AND PROCIDENTIA. 611 

with extensive lacerations of the perineum, the formation of 
a procidentia is not the rule, unless the woman is exposed to 
the risk by accidents, or from the character of her occupa- 
tion." He does not explain why this may be in early life 
and not when older. 

To my mind the explanation is to be found in the fact 
that in advanced years the muscular tissues — in fact, all the 
tissues — are more relaxed, and do not so readily regain their 
normal condition after delivery, as when younger. Hence, 
the fact which he gives regarding the immunity of }'oung 
women from procidentia, even though suffering from lacera- 
tions of the perineum, is the best of argument in favor of 
the position which I hold, that laceration of the perineum is 
not the principal cause of procidentia, though Dr. Emmet 
teaches, in another place, that it is, as I have quoted him. 
(Page 367, Emmet's "Prin. and Prac. Gynaecology.") 

In the descent of the uterus the vagina becomes partially 
inverted, and in complete procidentia it is completely so, and 
must necessarily either drag down into its inverted cavity 
the bladder and rectum, or must become torn loose from its 
attachment to the cellular tissue. It is usual that the blad- 
der is drawn down partially, and the course of the urethra 
is changed to a downward direction instead of upward. The 
small intestines are often found in the sac formed by the 
inverted vagina (see Plate XXVII). Their agency in caus- 
ing the displacement seems not to have occurred to the 
writers who have mentioned the fact of their presence down 
in this sac ten or twelve inches below their normal position. 
Calculi have sometimes formed in the bladder while thus 
prolapsed, and could be rattled together with the hand (Dr. 
G. Raper in Barnes's '-'Diseases of Women," page 545). 

In this condition of the bladder there is a great tendencv 
to cystitis 9 owing to the difficulty of voiding the urine, which 
causes a retention of stale urine, and this tends to produce 
cystic inflammation. 



612 EATON ON DISEASES OF WOMEN. 

At first it might be thought that very fleshy women 
would be more liable to prolapse than the spare built. Such 
does not appear to be the case in my experience, and is 
explained, I think, from the fact that most of the adipose 
is deposited exterior to the muscles, and although producing 
a pendulous abdomen does not cause greater pressure to be 
exerted upon the uterus than in those not fleshy, unless 
they should attempt to lace themselves down to a small 
size, in which case there would be a great tendency to pro- 
duce some form of displacement of the uterus. Fleshy 
women have usually good assimilative power and good diges- 
tion, and are well nourished, while in the slender, spare built 
woman this is often not the case; hence, the fleshy woman 
is not on that account more liable to prolapse. 

Diagnosis. 

In some women the uterus is situated abnormally low in 
the pelvis, and this condition appears to be congenital, as its 
deviation from the ordinary position produces no suffering or 
inconvenience. On careful examination, however, some of 
these cases will be found to be affected with elongation 
of the cervix, which gives the appearance on a careless ex- 
amination of a depressed condition of the entire organ. The 
history of these cases will usually show a previous cervicitis, 
which may have subsided so that little or no pain is experi- 
enced. If married, this condition is likely to produce sterility; 
but the consideration of this subject has been mentioned in 
connection with sterility and elongation and hypertrophy of the 
cervix. Most patients afflicted with prolapse suffer from bear- 
ing-down pain, a sense of weight in the pelvis, pain in the small 
of the back, frequent desire to micturate, etc. The severity 
of these symptoms depends much upon the suddenness of the 
displacement. When considerable prolapse comes on sud- 
denly these symptoms are more acute than when the dis- 
placement has come on gradually. 



PROLAPSUS UTERI AND PROCIDENTIA. 613 

Sympathetic Symptoms. 

Often in this displacement we have sympathetic symp- 
toms affecting the stomach, producing nausea (especially on 
rising), dyspepsia, gastrodynia, heartburn, etc. It also causes 
a variety of symptoms in the brain and spinal cord. Very 
frequently there is pain in the back of the head and neck ; 
sometimes burning heat on the top of the head, dimness of 
vision, pain and tenderness over the entire spinal column, 
etc. Sometimes we have hysterical symptoms, a changeable 
mood, crying and laughing in rapid succession, hysterical or 
imaginary pains in various parts of the body, and sometimes 
a condition of hyperesthesia of a part of the body, or some- 
times of the whole body. Hysterical spasms often supervene. 
These symptoms are usually aggravated or produced at or 
about the menstrual period. In other cases, instead of 
hyperesthesia there is a loss of sensibility in a part of the 
body, sometimes affecting one side of the body and not the 
other; sometimes there is a loss of both sensibility and 
motion in one limb or in one-half of the body. In still 
other cases there is a spasmodic condition of the oesophagus, 
making it almost or quite impossible to swallow. Palpita- 
tion of the heart, dizziness, fainting spells, are also indica- 
tive of this displacement. There is usually considerable pain 
and tenderness in one or both. iliac regions, caused from the 
inflammation which is often awakened in these cases from 
cold, as well as the irritation caused by the straining of the 
folds of the peritoneum and the laceration of the cellular or 
connective tissue, which often takes place. 

Among the symptoms sometimes manifested by nervous 
women affected with prolapsus, might be enumerated nearly 
or quite all the hysterical manifestations which are ever wit- 
nessed. These are not, however, peculiar to prolapse of the 
uterus, but are sometimes caused from other displacements, as 



614 EATON ON DISEASES OF WOMEN. 

well as any form of pelvic inflammation or spinal irritation. 
The only positive diagnosis is to be made in these cases 
by physical examination. First, a digital examination per 
vaginam is to be made while the patient is standing, if conve- 
nient. This examination reveals the os depressed in the pel- 
vis in some measure. (See Plate XXIV.) It may be but 
slightly prolapsed, or it may be found resting upon the per- 
ineum. (See Plate XXIII.) Or, in case of partial proci- 
dentia, the cervix is found pressing out between the labia, 
and if complete the whole organ is found external to the 
body. (See Plate XXVII.) 

Differential Diagnosis, 

The diseases and conditions which might lead to an error 
in diagnosis are a uterine fibrous pedunculated polypus, which 
has been expelled from the uterus, and is lying in the vagina, 
or is pressed out external to the vulva. The cervix, in com- 
plete procidentia, and in some cases of prolapse, is inflamed 
and enlarged so as to be out of all proportion to its normal 
size, and hence more care is necessary in its diagnosis. The 
distinguishing diagnostic point is the presence of the os 
uteri in the protruding or prolapsed mass. We must not 
be misled by a dent or fissure, and conclude it is the os 
till we make sure by the introduction of a probe or the 
uterine sound, that the cervical canal is there within the mass, 
as the polypus might have the fissure or dent in its depend- 
ent portion simulating the os quite perfectly. If the case 
was one of complete procidentia we could not pass the finger 
up by its side into the vagina, as the vagina is inverted and 
covers the protruding mass in its upper portion ; but if the 
mass was a, polypus with a long neck attached to the uterus, 
we could freely pass the finger up into the vagina all around 
the pedicle, and discover the os surrounding it as it entered 
the cervical canal. 



PROLAPSUS UTERI AND PROCIDENTIA. 615 

Diagnosis from Cystocele and Rectocele. 

These conditions may cause the patient to imagine she 
has procidentia, but it should not take the physician long to 
make out the correct diagnosis. The soft, fluctuating feel of 
these conditions, the absence of the os uteri, and finally 
passing the finger into the vagina and finding the os and 
cervix in position, settle the question. 

The Partially Delivered Fcetus. — The partially delivered 
foetus with a breech presentation may simulate prolapse. In 
both cases there may be backache and bearing down pains. 
But in prolapse there is usually no hemorrhage, while in a 
miscarriage there is. By passing the finger up around the 
mass in the vagina, to feel the anterior and posterior cul-de- 
sac of the vagina, we discover the os surrounding the mass, 
and by a little effort we dislodge it and bring it away. 

The Partially Delivered Placenta. — This may slightly 
resemble procidentia, in a case where we are not informed 
of a delivery having occurred. The placenta feels spongy, 
quite in contrast to the firm, rounded feel of the uterus. A 
little care will prevent an error of diagnosis. 

Diagnosis from Inversion of the Uterus. 

The condition of chronic complete inversion, perhaps, 
simulates complete procidentia more perfectly than any other 
condition (see chapter on Inversion as to differential diag- 
nosis). 

Treatment. 

Regarding treatment, I differ somewhat with most authors 
on diseases of women, Prof. Guernsey and Dr. Eggert 
teaching that remedies are alone the means of cure, and most 
other writers placing the greatest importance upon pessaries, 
narrowing the vagina by operation, restoring a lacerated peri- 
neum, and astringent vaginal washes, etc. I should, perhaps, 
except Prof. Ludlam. In his work giving a record of many 



616 EA TON ON DISEASES OF WOMEN. 

interesting cases, he incidentally mentions prolapse, and gives 
some remedies indicated, and intimates that other treatment 
is necessary, the description of which he seems to have in- 
advertently omitted. He mentions postural treatment in 
prolapse complicated with erosions of the cervix, with which 
I fully accord. 

Those physicians who believe in the cause of prolapse 
being want of tonicity in the vagina, and the sub-involuted 
condition of the uterus, and that procidentia is mainly due to 
a lacerated perineum, naturally attempt to cure the difficulty 
with astringent washes in the vagina, by pessaries to sup- 
port the uterus placed in the vagina, and in operations to 
lessen the size of the vagina, and cure the laceration of the 
perineum. 

Of the success of this plan we may judge from Dr. 
Emmet's own words,* and as he is a representative man of the 
old school, with the sanction of the entire allopathic profession, 
I' believe we may well take his words as representing the 
school to which he belongs. He says, after describing the 
operation : " This plan of operating disposes, most effectually, 
of all excess of tissue, and when union has been obtained 
the support is perfect. But with all its advantages one 
difficulty remains which I have never been able to overcome. 
In consequence of the, traction exerted in opposite directions 
the three flaps brought together almost always separate to 
some extent in the angle A, after the sutures have been re- 
moved, and this necessitates another operation." 

With this language he closes the discussion of the treat- 
ment of u procidentia and prolapse," after having devoted ten 
pages to the description of the operation required. This is 
not very encouraging. Still in hospital practice these cases 
afford interest to a class of students who are ever clamorous 
to see operations. Dr. Emmet has omitted to give us a table, 
showing the per cent cured under his care, although his 

* Emmet's Diseases of Women, page 283. 



PROLAPSUS UTERI AND PROCIDENTIA. 617 

tables are elaborate in showing how many commenced to 
menstruate at various ages. The age at marriage, average 
number of children each had been delivered of, the kind of 
labor each had suffered, etc., etc., etc. (I am sorry he omit- 
ted the number of cases cured.) 

He has, however, told us, on page 371, of an eccentric 
friend of his who claimed to cure every case among the 
negroes where he practiced, in ten days, by swinging them 
up in the knee-elbow position, and rilling the vagina with a 
strong decoction of oak bark. Dr. Emmet says, the princi- 
ple of treatment was correct, and be has it from others that 
the gentleman's claim to success was well founded. The treat- 
ment took off the weight of the abdominal viscera, replaced 
the uterus by gravity and atmospheric pressure, and the in- 
testinal and uterine supports regained their normal strength. 
No supports in the way of pessaries or operations were used, 
and still, as Dr. Emmet acknowledges, his friend had most 
excellent success. 

My wonder is that Dr. Emmet was not led to use the 
same principle of treatment, which he acknowledges is cor- 
rect, and which I believe to be the on/// true one. He does, 
it is true, speak highly of the advantages of position and at- 
mospheric pressure, on page 129 of his work, while writing 
upon the general principles of the treatment of displace- 
ments ; but in the treatment of special displacements he 
omits the recommendation for this plan of treatment, and 
one would infer from reading his remarks upon the treat- 
ment of prolapse and procidentia, that the main, thing was 
to support the uterus with a pessary, or sew up the vagina 
after cutting out a piece of its membrane. 

Objections to elytrorrhaphy, or, taking out a piece of the 
vaginal membrane. The first objection is, that it is unneces- 
sary. The second, that it is liable to fail in most instances, 
as Prof. Emmet has acknowledged * The third objection is, 

* Emmet, Diseases of Women, p. 383. 



618 EATON ON DISEASES OF WOMEN. 

that should pregnancy subsequently ensue, the narrowing of 
the vagina by the operation might interfere materially with 
the delivery of the child at full term, either preventing the 
delivery, or causing a laceration of the vagina to occur in 
its expulsion. In the very aged, or in those who have 
passed the climacteric period, this last objection is, of course, 
invalid; but the first two would deter me from the operation. 
There are other means of affording relief, if not a cure, in 
these older cases, of which I will speak hereafter. 

The first and most important point in the treatment of 
prolapse, in my judgment, is to take off from the uterus all 
weight that may be pressing upon it. The wearing of cor- 
sets or clothing suspended from the waist must be forbidden. 
The weight of the intestines pressing clown upon the pro- 
lapsed uterus must be removed by some means; and just 
here much ingenuity is required to adapt means to secure 
this end, in the variety of patients who come under our 
care. The knee-chest position, as practiced by Dr. Emmet's 
friend (previously mentioned), accomplishes the object; still 
we can not, in general practice, swing our patients up, as 
this gentlemnn did his negress patients (though I am some- 
times tempted to do it). The reason of his great and rapid 
success probably lies in the fact that his cases were com- 
paratively recent displacements in women of strong consti- 
tution and firm muscular development, rather young in years, 
and, consequently, the tonicity of the intestinal supports was 
soon restored, when every particle of strain and weight was 
taken from them. 

Causing our patient to lie upon the side with the hips 
elevated for several weeks will accomplish about the same 
results. In those cases where their employment or circum- 
stances make it necessary for them to be up and at work, 
some form of abdominal support is necessary. I prefer the 
Improved London Suppo?*ter for this purpose, giving attention 
to the fit of the instrument, and making sure that it acts as 



PROLAPSUS UTERI AND PROCIDENTIA. 619 

an abdominal supporter \ and not as an abdominal compressor . 
Daily cause the patient to assume the position on the side, 
with the hips elevated, for an hour or so, and, separating the 
limbs, press the uterus upwards with the fingers; then in- 
sert into the vagina a common, round vaginal speculum of 
suitable size to be readily retained. This allows of the free 
introduction of atmospheric air, and from its pressure it re- 
lieves the engorgement of the capillaries of the vagina and 
cervix, and presses the organ into position. Now, before the 
patient changes her position, apply the Improved London Sup- 
porter (see cut in Plate XII), so that when the patient as- 
sumes the sitting or standing posture the abdominal organs 
will be held up away from the uterus. 

Use warm water vaginal injections daily, and such other 
treatment as the complications demand, with remedies used 
according to their indications, and the recent case of pro- 
lapse or procidentia will be, as a rule, speedily cured. 

The chronic cases which have existed for years may re- 
quire that some force be used by the physician to break 
loose attachments which often are found to have formed in 
the cellular tissues, binding the organ down in its unnatural 
position. In some cases these adhesions are so strong as to 
make it impossible to lift up the uterus by any means, and 
such attempts have to be abandoned. In other cases we 
may cause these attachments to gradually give way by the 
use, in the vagina, of the inflatable gum-elastic bag, which 
we may insert after pressing up the uterus as high as the 
attachments will allow, and then inserting the bag and in- 
flating it as fully as possible with the tube, which is left ex- 
ternal to the body. The air in the bag is retained with a 
stop-cock, or by means of a string tied tightly around the 
tube. This exerts a steady, but soft and gentle, pressure 
upon the uterus, carrying it upwards as high as the attach- 
ments will allow, and frequently causes them to give or re- 
lax and allow the uterus to be normally located. This means 



620 EATON ON DISEASES OF WOMEN. 

is to be used with the patient in the knee-elbow or side po- 
sition, and with the abdomen supported if she rise, as in the 
recent case. In some cases the physician will have to re- 
move and reinflate the rubber bag every three days; in 
others, the patients can do it themselves. 

In instances of lacerated perineum complicating the case, 
the perineal bond and compress may be needed to retain the 
inflated bag within the vagina and exert sufficient pressue to 
avail any thing in the removal of the attachments. The 
length of time which it is advisable to use this treatment to 
restore the uterus when partially attached in its abnormal 
position varies much; usually, however, not more than two 
or three weeks, and sometimes only that many days; but 
the use of the abdominal supporter should be continued for 
several months, especially if the patient has to go about or 
work much. 

Dietetic and hygienic measures must not be overlooked. 
Attention to food, rest, sleep, exercise, clothing, bathing, etc., 
is always necessary. The bowels must be kept regular with 
enemse of soap and w T ater, if inclined to constipation, as 
straining at stool is particularly to be avoided in all cases 
of displacements, and especially in prolapse. 

Treatment of Complete Procidentia. 

In cases of complete procidentia which have become 
chronic, there are sometimes serious obstacles to the return 
of the mass even within the vagina. Sometimes the uterus 
and vagina covering it becomes inflamed, swollen, and oede- 
matous. In this case the mass should be wrapped in a cloth 
well saturated with equal parts of Glycerine and Tr. Hydras- 
tis ; over this we may wrap a cloth wrung out of warm water, 
and over that again apply a dry flannel. If the oedema is not 
relieved in a few days, we may puncture the most swollen 
portion of the mass with a goocl-sized surgeon's needle in sev- 
eral places, and allow the serum and blood to drain away, 



PROLAPSUS UTERI AND PROCIDENTIA. 621 

still continuing the local application just mentioned till the 
mass is much lessened in size, when the attempt at replace- 
ment should be made, first placing the patient in the knee- 
chest position or on the side, with the hips elevated and the 
body low. 

After succeeding in replacing the mass within the body 
we should wait a day or two, keeping the patient in the side 
position, with the hips elevated, so as to allow the force of 
gravity to do all in its power to restore to position, not only 
the uterus, but the displaced intestines as well. We may 
then make further attempts to lift the uterus into its normal 
situation, having the patient placed in one of the positions 
mentioned. This can be readily accomplished in most cases 
with two fingers passed up into the vagina, after which the case 
is to be treated as directed for the recent case of prolapse, 
only bearing in mind that a longer time will be required in 
the treatment than is usual in the recent case, and that we 
are liable to be troubled with occasional relapses from the 
imprudence or carelessness of the patient- 
Cases sometimes occur where the bowels have formed 
adhesions in the pouch formed in the pelvis in the descent 
of the uterus, bladder, and ovaries, on account of inflamma- 
tory action; and it may, hence, be impossible to replace these 
organs. Dr. Barnes* says: "The extreme pain which at- 
tends the attempt to return the procident mass into the pelvis 
is often due to some degree of inflammation having been set 
up in the peritonaeum lining, the pouch into which the intes- 
tines descend, at the upper and back part of the womb, or 
of the peritoneal investment of the intestines themselves; 
and death may in these circumstances take place, with many 
symptoms of the same kind as attend upon fatal strangulated 
hernia or ileus" He further says : "Another cause of the 
bulk of the tumor, and of the difficulty in replacing it, arises 
from the presence of the intestines in the sac, which seldom 

* Barnes's "Diseases of Women/' p. 568. 



622 EA TON ON DISEASES OF WOMEN. 

reside there long without inflammation of their peritonseal 
coat being set up, not of so acute a character as to produce 
formidable symptoms, but matting their different coils to- 
gether, and tying them firmly to the interior of the sac." 

The only treatment which can be given these cases, where 
adhesions have formed, is palliative in character, if complete 
procidentia is present. This palliative treatment consists of 
holding up the protruding mass in a sling attached to a band 
around the hips, drawing off the urine with a catheter, if 
necessary, and treating any inflammation which may arise 
Avith those remedies most clearly indicated. 

Restoring the Perineum. — In my opinion an operation to 
restore the perineum is never required in the treatment of 
procidentia. When the laceration includes the sphincter ani 
it is necessary to operate sufficiently to enable the patient 
to retain the feces; but for the purpose of preventing the 
return of procidentia it is valueless, or nearly so, unless we 
also cause such a constriction of the vagina as to make a 
descent of the uterus physically impossible. In this case 
the natural delivery of a child is impossible, and in some 
instances copulation even is out of the question. 

Dr. Barnes,* of London, says of the operation to restore 
the perineum in these cases : "As we have seen, the poste- 
rior wall of the vagina and the perineum form a most efficient 
support for the anterior wall. Much benefit might, therefore, 
reasonably be expected from making good this part. Mr. 
Baker Brown was one of the earliest and most earnest advo- 
cates of this plan. A considerable number of operations of 
this class have been performed by him and others, and with 
varying degrees of success. But then there are clinical ob- 
servations in abundance to prove that it is based upon im- 
perfect appreciation of the cause of the prolapsus. In many 
of the cases, notwithstanding the narrowing of the posterior 
wall of the vagina and the union of the labia, much anterior 

* Barnes's " Diseases of Women." 



PROLAPSUS UTERI AND PROCIDENTIA. 623 

to the normal fourchette, the prolapse after a time returned. 
The true factors of the prolapsus remaining untouched, grad- 
ually the uterus made its way down again, and, distending, 
the new perineal floor appeared outside the vulva. Nor is 
the relief often permanent, unless the vulva be almost com- 
pletely occluded. It has been seen that the small vulva and 
perfect hymen of the virgin are not an absolute safeguard 
against prolapsus. The narrowing of the vulva simply forms 
a shelf to receive the falling uterus." 

Perineorrhaphy. — Perineorrhaphy is a name given by 
Prof. Thomas* to an operation for restoring the perineal 
body. The idea is to make by this operation a firmer and 
thicker perineum. 

The operation consists in dissecting out a piece of vaginal 
membrane from the interior of the perineum. It may vary 
in size, according to the case, from two to three inches in 
length, and from one to two inches in width. And then 
place sutures so as to draw together the opposite sides of the 
vagina, thereby narrowing its capacity at its inferior extrem- 
ity. The operation is not difficult; but still we do not rec- 
ommend it, for the reason that we do not find need for it, 
and believe there are easier and better ways of treating 
prolapsus of the uterus. 

Elytrorrhaphv. — Elytrorrhaphy is an operation for nar- 
rowing the vagina in its upper portion, which is about as 
useless as perineorrhaphy, though much more difficult. In 
the first quarter of the nineteenth century the operation 
was performed in England and Germany. In 1858 Prof. 
Simsf revived the operation, which had for many years 
fallen into disuse. The late Prof. A. G. Beebe reported, 
about five or six years since, to the Illinois State Homoeo- 
pathic Medical Association, several successful operations per- 
formed by himself. 

* Thomas's " Diseases of Women," p. 349. 
tSims's "Uterine Surg.," Eng. ed., p. 309. 



624 EATON ON DISEASES OF WOMEN. 

The only cases in which we think the operation of ely- 
trorrhaphy is allowable at all are those cases of quite old 
women who are troubled with procidentia uteri, and who, for 
some reason, prefer to be operated upon to having the trouble 
of using other suitable treatment. 

The operation, to be of any use, must remove a large 
piece of the vaginal membrane so as to effectually narrow 
the canal to a very small size. In performing the operation 
we should remove a diamond-shaped piece of vaginal mem- 
brane, the longest diameter of which is lengthwise the vagina, 
for otherwise a pouch might be formed, in which would accu- 
mulate secretions which would become irritating by their long 
retention. There is liability to great hemorrhage from the 
large extent of surface required to be dissected off, and this 
class of patients are, as a rule, unprepared to stand the loss 
of blood, the effects of the anaesthetic required, and the 
operation. 

I will not enter into a minute description of the steps in 
the operation. The student understands that the patient 
must be placed upon her side or back on the operating table, 
and an anaesthetic administered; that the vagina must be 
dilated with retractors held by assistants. He knows that 
a tenaculum will hook up the vaginal membrane, and that a 
scalpel will cut it, and that if he has skill enough he may dis- 
sect out a large piece of vaginal membrane and then stitch the 
opposite sides of the denuded space together with silver wire, 
as he would do in a case of vesico-vaginal or recto- vaginal 
fistula ; that the stiches may well remain about the same time 
as when used in the treatment of fistula. His judgment 
should teach him that for at least two weeks the patient 
should remain in a horizontal position, etc., etc. So, if he 
ever feels blood-thirsty, and he has a patient wishing to be 
operated upon, he may go ahead and perform the operation 
of elytrorrhaphy. 

There are authorities enough who justify and recommend 



PROLAPSUS UTERI AXD PROCIDENTIA. 625 

the operation. We, however, give the advice to use the 
homceopathically indicated remedies in prolapsus, and conjoin 
rational support to the abdominal viscera, supporting the 
uterus even (in cases of very old women) with the T ban- 
dage, a Babcock supporter, or the inflatable pessary, and al- 
low the old ladies to live their few remaining days with all 
their vaginal membrane intact. 

Remedies. 

Great good is accomplished with remedies, especially when 
used in connection with the postural treatment in recent cases, 
and with young women. They are useful in any case, but 
strikingly so in some of the class just mentioned. 

The remedies useful in prolapsus are not always used for 
their direct effect upon the uterus or its appendages, nor 
even upon the abdominal organs or vagina, for the reason 
that the sympathetic affections which are produced by pro- 
lapsus uteri are so numerous and varied that it is sometimes 
necessary to meet these symptoms with indicated remedies. 
We can not, therefore, expect to mention eveiy remedy 
which might be useful in some particular isolated case, but 
will record those most frequently indicated ; for, should we 
attempt to recount all the remedies which might possibly be 
of use, especially for the nervous symptoms and those of 
hysterical nature, we would have to make up quite a, materia 
medica. 

Local Remedies. — These we mostly discard, although in 
some cases the complications in these patients make a resort 
to them advisable. 

In case we have metritis, endo-metritis, leucorrhcea, cystitis, 
erosions of the cervix, etc., some local applications to the 
uterus direct are of great benefit ; but as we have discussed 
them under their appropriate chapters, we will not repeat 
them here, further than to mention the almost universal in- 
dication in these cases for the use of warm sitz baths, or 

40 



626 EA TON ON DISEASES OF WOMEN. 

warm vaginal injections of pure water. These may be used 
daily in almost any case of prolapse or complete procidentia, 
with great comfort and benefit. 

The remedies most frequently indicated internally are, 

Nux, Aconite, Bell., Sepia, Cant liar ides, Secale, Puis., Lycopod., 
Colocynth., Aloes, Plumb., Arnica, Hyosc, Cimicif., Oak. carh., 
Can. ind., Dig., Ignat., Pry., China, Ars., Iris vers., Lilium 
tig., Sulph., Phos., Sabina, Calc, Plios, Aurum, Petroleum. 

Special Indications. 

Aconite. — Tenderness of the cervix uteri; general con- 
gestive and feverish condition; tenderness in any part; 
suited to timid ladies ; despondency, indicated especially in 
plethoric women; acute catarrhal conditions; great restless- 
ness ; loss of sleep ; palpitation of the heart, etc., etc. 

Arsenicum Alb. — Prolapsus, with erosions of the cer- 
vix; corroding leucorrhoea, ; great thirst; alternately feeling 
heat and cold; hot, but shivering; burning hands and feet; 
nausea; diarrhoea of a cadaverous odor; burning sensation 
in abdomen; great prostration of strength, with irritation of 
the mucous membranes, characterize this remedy. 

Auruin. — Heaviness in abdomen, and coldness of hands 
and feet. 

Belladonna. — Prolapsus, with pressure as though all 
the abdominal organs would be pressed down through the 
vagina; spasmodic pain in the uterus; inflammation of the 
uterus, with cerebral congestion; dullness of intellect; com- 
plete procidentia, with erysipelatous condition of the pro- 
truding mass ; spasmodic cough ; difficulty of swallowing, 
from spasmodic closure of the oesophagus ; takes cold easily ; 
bathed in perspiration; right side most affected; paralysis of 
one side of the face; sore throat; tonsils red and swollen; 
spasmodic twitching of some of the voluntary muscles ; dila- 
tation of the pupil; painful micturition. 

Bryonia. — In prolapsus, with darting, piercing pains; 



PROLAPSUS UTERI AXD PROCIDEXTIA. 627 

constipation; great nausea; nausea and pain, aggravated by 
motion. (Consult Coperthwaite's Mat. Med.) 

Calc. Carb. — Prolapsus with leucorrhoea; light com- 
plexionecl women of scrofulous tendency most benefited; 
distressing bearing down pain, with inflammation of the 
vulva; menses profuse and frequent; great emaciation with 
bloated abdomen; excessive adipose development. 

Cannabis Indica, — Prolapsus, with jerking in the abdo- 
men; profuse leucorrhoea; catarrh of the vagina, etc. 

Cantharides. — Prolapsus with sterility; loss of sexual 
desire ; pain at the base of the brain ; constant desire to 
urinate; spasmodic condition of the larynx, with mucous 
stools; excessive sexual desire. 

China. — Prolapsus after miscarriage, with great loss of 
blood. (For other indications, consult Burt's or Allen's Ma- 
teria Medica.) 

Colocynthis. — Prolapse with sharp cutting pains in the 
abdomen, especially around the navel; violent sciatic pain, 
with thick viscid urine. 

Coninm. — Prolapsus, with induration of the cervix; ex- 
cess or want of feeling, accompanied with sterility. 

Digitalis. — Prolapsus, with palpitation of the heart; diffi- 
culty of breathing; motion produces faintness ; smell of food 
excites nausea. 

Ignatia. — In prolapsus, with piles; pains shooting deep 
into the rectum; throbbing pain in occiput; hysterical 
symptoms. 

Iris Versicolor. — Prolapsus, with burning distress in the 
stomach; watery, burning diarrhoea; very useful in cases 
afflicted with sick headache. 

Kali Plios. — Prolapsus, with rheumatic pains ; sufferings 
from great grief; diarrhoea; leucorrhoea; takes cold easily. 

liliimi TigTiimm. — Prolapsus, with intense bearing 
down pains, with depression of spirits (a very useful remedy). 

L-ycopocliuni. — Prolapsus with constipation ; straining at 



628 EA TON ON DISEASES OF WOMEN. 

stool ; dryness of the vagina ; sharp pains in the labia ; 
flatulence; severe pain in the back; red sand in urine; ten- 
dency to hepatic disease. 

Nux Vomica. — Pain in the back and head; bearing 
down pains in abdomen; constipation; indigestion; fetid 
leucorrhoea; irregular menstruation; too profuse menstrua- 
tion; bad dreams; debility; trembling of the limbs; loss of 
appetite ; cases complicated with piles or fissure of the anus ; 
hemorrhage from the bowels ; incontinence of urine and 
bloody urine; paraplegia, and effects following spinal irri- 
tation. 

Petroleum. — Prolapsus, with troublesome diarrhoea; irri- 
table temper; very useful in chronic inflammation of cervix; 
gastralgia; burning of palms of hands and soles of feet. 

Phosphorus. — Prolapsus, with weakness; excessive, or 
lack of, sexual passion; corrosive leucorrhoea; great debility; 
constipation; cold extremities; nervous exhaustion. 

Pulsatilla. — Prolapsus with scanty menstruation; sour 
stomach; menstrual blood thick and dark; tendency to faint- 
ing spells; indigestion; thick white albuminous leucorrhoea. 

Sabina. — Prolapsus, with quivering sensation in abdo- 
men; copious leucorrhoea; prolapsus, with threatened abor- 
tion; excessive plethora. 

Secale. — Prolapsus with severe bearing down pain ; fear 
of death; melancholy, accompanied with passive hemorrhages 
from the uterus or rectum. 

Sepia. — Prolapsus, with painful pressure in the vagina; 
burning, stitching pains in the neck of the uterus ; complete 
procidentia; profuse leucorrhoea; troublesome itching of the 
vulva; very sensitive to cold air; sad, dejected mood, 
Avith fetid urine depositing a clay-colored or reddish sedi- 
ment, which adheres to the vessel as if burnt on; dyspar- 
eunia or vaginismus ; bad smelling leucorrhoea ; nausea in 
the morning; spasmodic dry cough, etc. 



LACERATION OF THE VAGINA. 629 



CHAPTER LIII. 

LACERATION OF THE VAGINA— LACERATION OF THE PERIN- 
EUM— ULCERATION [TUBERCULOUS, CANCEROUS, AND SYPH- 
ILITIC). 

Laceration of the vagina occurs most frequently as a 
result of labor where the vagina is not well relaxed and the 
uterine contractions are very strong. Laceration of the 
perineum is frequently complicated with laceration of the 
vagina when it is produced from this cause, or violent 
traction in delivery with forceps, or by pedalic version. 

Laceration of the vagina may occur from other causes, as 
the breaking in the vagina of a glass vaginal syringe, or by 
being hooked by an animal, or falling upon something stiff 
and sharp. Dr. James* reports a case where a woman was 
impaled upon the prong of a hay fork, which passed between 
the cervix uteri and the rectum, penetrating the abdomen 
as far as the ribs. (The lady recovered.) Gotthardtf re- 
ports a case of spontaneous rupture of the vagina from a fall. 

Lacerations from traumatic causes usually implicate the 
bladder, uterus, rectum, or peritoneal cavity, causing some 
form of vaginal fistula. 

Ulceration of the vagina is due in many instances to the 
long continued pressure of the head of the child in the pelvis 
during confinement, and it may result from the wearing of 
hard pessaries. The various fistulse of the vagina are liable 
to result from these ulcerations. 

Syphilitic and tuberculous ulcerations are not likely to 
cause fistulse, being mainly confined to the mucous membrane 
of the vagina, and occurring, in connection with other man- 

* Boston Gyn. Jour., Vol. 3, p. 175. 
t Werner Med. Woch., 1869, No. 94. 



630 EATON ON DISEASES OF WOMEN. 

ifestations of these diseases, in other parts or organs of the 
body. 

Cancerous ulceration of the vagina is usually the result 
of its extension from the cervix uteri, and may destroy all 
the adjacent organs. The cancerous cachexia is observed in 
these cases, characterized by the yellowish brown, sallow, 
wrinkled condition of the skin all over the body. 

Treatment. 

In case of lacerations of the vagina, which affect the 
vaginal membrane only, injections into the vagina of warm 
water, to which a little of the Tr. of Calendula is added, is 
all the treatment required. In cases where the peritongeal 
cavity is penetrated the exclusion of atmospheric air to as 
great an extent as possible should be attempted, by wearing 
oiled silk over the external genitalia, held in position with a 
compress of cloth and a T bandage, after stitching the lacera- 
tion together with silver wire interrupted sutures, and keeping 
the patient lying on her side with the hips elevated. 

When the bladder or rectum or perineum are implicated, 
they are to be treated as directed under the heads of lacer- 
ated perineum, vesico-, and recto-vaginal fistulse. 

Syphilitic ulceration, as well as the tuberculous and can- 
cerous require the same treatment as when occurring in other 

localities. 

Fissures of the Vagina.. 

Fissures of the vagina may exist around the os vaginam, 
as a result of violent coitus, the use of a speculum of too large 
a size, or may be the result of slight lacerations in confinement. 
Ordinarily they heal readily, but, in some cases, owing to the 
want of plasticity of the blood, or on account of frequent in- 
jury, they become chronic, and show no disposition to heal. 
In such cases the sharp-pointed stick of Argentum nit., ap- 
plied to the base of the fissure once in three days, and smear- 
ing the parts with Basilicon Ointment, is the way to effect a 



LACERATION OF THE PERINEUM. . 631 

healing rapidly. The general condition of the system must 
not be overlooked, and remedies which are homoeopathically 
indicated by the symptoms should be given. The parts may 
be bathed with tepid water frequently, though gently. Sexual 
congress must be strictly prohibited till the fissures are well. 

Laceration of the Perineum. 

Laceration of the perineum takes place in cases of rapid 
deliveries, where the vagina is not well relaxed, and from 
undue traction upon the head of the child in delivery by 
forceps, or in pedalic version where the head of the child is 
large, and the vagina not completely relaxed ; and from the 
unrelaxed condition of the vagina in natural delivery, where 
the head of the child distends the perineum for a long time, 
cutting off the circulation of the blood from the distended 
tissues. Slight lacerations quite frequently occur, and heal 
without special treatment. 

The lacerations of the perineum occur in various degrees, 
from the very slight to complete laceration of the perineum, 
implicating the rectum and dividing the sphincter ani. This 
throws the vaginal and rectal outlets into one common pass- 
age. In these extensive lacerations, the vaginal wall is lacer- 
ated from one to three inches. The feces and flatus from 
the bowel can not be retained, and pass away involuntarily 
and unconsciously. 

Laceration of the perineum occurs as a result of external 
violence occasionally. This accident may happen in this 
way to young girls or old women as well as the middle aged. 

Laceration of the perineum most frequently occurs in 
women who are being delivered of their first child, and if the 
lady is middle aged, the delivery of her first child is more 
hazardous in this respect than when younger in years. Of 
course, lacerations do sometimes occur in women who are 
quite young, and have had several children previously. This 
may result from their previously having had a slight lacera- 



632 . EATON ON DISEASES OF WOMEN. 

tion, which, in the healing, left a cicatrix which would not give 
or relax, and hence results an extensive laceration. Possibly 
the midwife is to blame, in some cases, for allowing labor to 
progress rapidly while the tissues are rigid about the vag- 
inal outlet. 

Inattention to giving the head of the child proper support 
while passing the perineum may cause a laceration, even in 
those cases where there is a good degree of relaxation of the 
perineal and vaginal tissues. 

Diagnosis. 

After a laceration of the perineum the patient complains 
of a smarting, burning pain in the parts, even if the lacer- 
ation be slight. When it is extensive, the pain and smart- 
ing is usually severe. These complaints made by the patient 
should indicate to the medical attendant the necessity of 
physical examination. By passing the finger into the vagina 
and moving it from side to side over its posterior surface, 
the laceration is readily detected in the solution of contin- 
uity of the vaginal membrane. We then withdraw the fin- 
ger and place it upon the anus, and passing it forwards de- 
tect the extent of the laceration. There is no call for ocular 
inspection of the perineum, to make out the diagnosis. I 
am aware that Dr. T. G. Comstock,* of St. Louis, recom- 
mends ocular examination of every case of confinement, to 
see if a laceration of the perineum exists. This may be 
done in a hospital, but I think would not be considered just 
the thing to do in private practice. 

Dr. Emmet f claims that "a laceration of the perineum 
is sometimes accompanied by a general irritability, which can 
not be traced to any other cause, and is only relieved when 
the perineum is restored. I have known several instances in 
which the existence of scars in the perineum had so much 

* U. S. Med. Investigator, July 1, 1880, p. 39. 
t Emmet's Prin. and Prac. Gynaecology. 



LACERATIOX OF THE PERINEUM. 633 

effect upon the nervous system as to entirely change the dis- 
position of the woman, and yet they were not conscious of 
any local difficulty." 

Now. it has not been our experience that such results 
follow slight lacerations or even scars of the perineum; still 
we give the student the suggestion from Dr. Emmet. The 
perineal body has not by its anatomy any peculiarity which 
would make a laceration of it any more likely to cause ner- 
vous symptoms; than would result from scars or lacerations 
anywhere else, and we do not think that experience shows 
that they do. We do not think that slight lacerations of 
the perineum interfere with involution of the uterus after 
confinement, as is claimed by some ; neither do they materially 
aid in causing prolapsus uteri ; but they do cause sterility by 
allowing of the discharge of the semen from the vagina be- 
fore it is drawn up into the uterus. They are not desirable, 
as they interfere with sexual congress by preventing the con- 
traction of the sphincter vaginae, thereby tending to prevent 
the sexual orgasm in both sexes. 

Treatment. 

In recent slight cases the treatment consists in putting 
the parts in apposition, by placing the patient upon her side 
and tying the knees together to prevent their getting sepa- 
rated, and thereby cause the breaking loose of any feeble 
attachments which may form. The bowels should be con- 
stipated, in extensive lacerations, for eight or ten days, by 
giving Opium in Mother Tr. about ten drops every eight horns. 
Evacuate the bladder with the catheter twice a day. or leave 
a self-retaining catheter in the bladder. (See Plate XIII.) 
If the laceration is so extensive as to implicate the anus in 
the rent, the taking of three or four deep sutures, at once, is 
advisable. The interrupted suture may be used, or the quill 
suture is applicable, if preferred, as we will describe in the 
operation necessary in old cases of laceration. 



634 EATON ON DISEASES OF WOMEN. 

When the laceration is small in extent, there is no need 
to constipate the bowels or use sutures. They may move 
aided by warm water enenme, every two or three days. The 
limbs must be kept tied together, and gentle, bland nourish- 
ment, only, must be allowed. Tepid water, to which a little 
Tr. Calendula is added, may daily be very gently thrown into 
the vagina, always keeping the patient on her side. This is 
for the purpose of preventing the discharges from the uterus 
from getting into the laceration, and preventing union, which 
would be likely to result if the patient was upon her back. 

Many cases even of extensive laceration will heal promptly 
if the foregoing directions are strictly followed ; still I would 
place sutures in extensive lacerations, thereby preventing the 
possibility of a tedious and sometimes troublesome operation 
afterwards, as well as having the advantage of giving much 
comfort to the patient in the possession of health and avoid- 
ing the dread of an operation afterwards. Another advan- 
tage of prompt and efficient treatment consists in the saving 
of tissue which is necessarily lost in operating upon old lac- 
erations, in order to freshen the edges of the tear and enable 
union to take place. Again, the inherent resources of nature 
which supply the plastic material to restore solutions of con- 
tinuity, either in the bony, fleshy, or mucous tissues of the 
body, seem to be more active directly after the injury is re- 
ceived than at any subsequent period. 

The case of chronic laceration of the perineum must be 
made to simulate the recent case, by freshening the edges of 
the rent in the vaginal, muscular, and cutaneous tissues, 
which have become covered by a sort of mucous membrane. 
We have made a drawing (Fig. 61), to represent the tissues 
which are lacerated and the position of the sutures to be 
taken where the laceration includes the recto-vaginal septum. 

Operation. — First the patient should be in as good a condi- 
tion as possible. If the general health is in bad condition, we 
are not likely to obtain union of the edges of the laceration. 



LACERATION OF THE PERINEUM. 



635 



The bowels should be freely moved previous to the operation. 
The lady should lie upon a conveniently high operating 
table, upon her back, being suitably clothed in woolen drawers 
and stockings, with the knees flexed upon the abdomen, and 
well separated by an assistant upon each side, who should 
also each hold a vaginal retractor to separate the lateral 




Fig. No. 61. — Laceration of the Perineum. 



walls of the vagina from each other, and bring the entire 
laceration into view, after the patient has been given an 
anaesthetic. 

We next proceed to denude the lacerated surfaces of the 
mucous membrane developed over them. If the laceration 
implicates the recto-vaginal septum, we make two operations, 



636 EA TON ON DISEASES OF WOMEN. 

the first to cause a healing and closing of the recto-vaginal 
septum, and afterwards of the rupture of the perineum; 
although instances might occur where it would be advisable 
to perform the whole operation at once. 

In case we are to make two operations, we only denude 
the tissues which are to be approximated to form the recto- 
vaginal septum. Commence at the lowest portion of these 
tissues to be united, and seize the mucous membrane with a 
tenaculum, and incise its lower portion with scissors or small 
scalpel ; then proceed to lift up and dissect off as rapidly as 



Fig. No. 62. — Bozeman's Straight Scalpel. 

possible, either with scissors or scalpel, all the surface we 
wish to bring in contact with the opposite side. (Both op- 
posed surfaces must, of course, be denuded.) 

We then insert the silver wire interrupted sutures, the 
same as in recto-vaginal fistula (after arresting any hemor- 
rhage we may have caused), placing the uppermost suture 
first. Here my wire holder and twister will be found very 
convenient in fastening the sutures (see chapter on Instru- 
ments, Plate VI). Place as many sutures as are necessary 
to restore the recto-vaginal septum by placing them one- 
third of an inch apart, the number required varying accord- 
ing to the extent of the laceration. 

In case we see fit to perform the whole operation at 
once, the entire surface, triangular in shape, as represented 
in the cut No. 61, must be freshened, and after placing the 
sutures tp restore the recto-vaginal septum, as I have just 
described, we turn the patient upon her side, letting the 
knees come together, having the uppermost buttock lifted up 
by an assistant, to be out of the way. We may now take 
from three to five deep sutures in the perineum, placing the 
first just at the margin of the anus and the others at inter- 



LACERATION OF THE PERINEUM. 637 

vals of a half inch anterior to it, using Peaslee's improved 
perineum needles, or strong curved surgeon's needles. We 
place these sutures deeply enough to include the vaginal 
membrane, having the last one anteriorly placed so far for- 
ward as to draw together some little of the tissue not fresh- 
ened. This will be found in practice a useful suggestion, 
causing the restoration of a more complete and symmetrical 
fourchette than can otherwise be accomplished. 

To insert a quill suture we must have a needle which has 
its eye about one-half inch back from the point, and is made 
somewhat semi-circular — it should be at least three inches in 
length, and fastened into a straight handle. (See Peaslee's 
improved perineum needles, Plate VI, chapter on Instruments.) 
The needle is threaded with silver wire, and inserted deeplv, 
from side to side, carrying the point of the needle through the 
cutaneous surface of the opposite side to the one through 
which it is first inserted, far enough to enable us to pass a 
tenaculum through the loop of wire carried by the needle. 
We now make a little traction upon the tenaculum, so as to 
draw a little of the loop through the tissues, and holding it 
firmly, withdraw the needle by the side of the wire. We 
now insert a piece of No. 6 bougie through the loop of w T ire, 
and make slight traction upon the ends of the wires, suf- 
ficient to tighten the loop over the bougie. We now 
thread the needle with another piece of w T ire, or use another 
needle already threaded, and insert another suture in the 
same way, placing the first suture in the margin of the 
anus if it is implicated, or near it in case it is not torn, 
using a sufficient number of sutures to bring the laceration 
w T ell together, placing them about one-half an inch apart and 
slipping the piece of bougie through each successive loop as 
it is inserted. 

In placing these the patient may most conveniently lie 
upon her back, with the limbs well drawn up, as required for 
freshening the edges of the laceration, and, after the sutures 



638 



EA TON ON DISEASES OF WOMEN. 



are placed, we turn the patient on her side, tighten up the 
ligatures so as to evenly approximate the lacerated surfaces, 
by taking the two wires of each suture and twisting them 
together over a piece of bougie like the one placed through 
the loops of the sutures upon the opposite side. (See Fig. 
No. 63.) 

After these sutures are placed and tightened around the 
piece of bougie or quill, as was formerly used, superficial 
_^ stitches between the 



deep ones may be taken 
just to include the cu- 
taneous tissue, approx- 
imating it more evenly; 
and these may be re- 
moved in about four 
days. The ends of 
the sutures should be 
wrapped together in a 
piece of soft cloth, to 
prevent their irritating 
the thighs. 

After Treatment. — 
As soon as the opera- 
tion is completed the 
patient may be re- 
moved to her bed, first 
tying the knees to- 
gether. After the pa- 
tient , has recovered 
from the anaesthetic, 
ten drops of Tr. Opii 
may be given and repeated every eight or ten hours for two 
or three days, when the dose may be reduced to five drops 
if the bowels show no disposition to move. Beef tea, soup, 
milk, etc., should constitute the diet for ten days or two 




Fig. No. 63. — Quill Suture Adjusted in Cases of 
Lacerated Perineum, 



LACERATION OF THE PERINEUM. 639 

weeks. The urine should be drawn off with a self-retaining 
catheter. No vaginal washes are required, nor should they 
be allowed. In the recent case, following confinement, we 
recommend them to wash away the discharges from the uterus 
which follow ordinary delivery ; but in the old case, Ave have 
no need of them, and when they are needed in the recent 
case, they should be used while the patient is on her side 
inclining towards the face. 

Time for the Operation. — The time to be selected for an 
operation for the restoration of the perineum is within a few 
days after the menstrual flow (if the menses have come on 
since confinement), in order to get the parts healed before 
the next period. 

Cautions. — In placing the sutures do not draw them too 
tightly. There is more liability to make a mistake in this 
direction than in any other. When the sutures are drawn too 
tightly the normal circulation is arrested, and sloughing re- 
sults, making not only a failure of the operation, but making 
any subsequent operation extremely difficult or impossible, 
owing to the loss of tissue from the sloughing. 

Do not be induced to allow the patient to pass her urine 
for ten days without the use of the catheter, on account 
of the danger of its getting into the laceration and pro- 
ducing irritation. It is better that it be not allowed to 
dribble in the least down upon the freshened lacerated 
tissues. 

If the anus or recto-vaginal septum is included in the 
laceration do not allow the bowels to move for at least eight 
days. When it is not involved they may move regularly. 
Reason and experience teach us that the passage of feces 
through the rectum and anus will tend very materially to 
disturb the healing process by breaking loose feeble attach- 
ments in the parts. 

Do not make frequent examinations of the tissues to see 
how they are getting along. Perforin the operation properly, 



640 EA TON ON DISEASES OF WOMEN. 

and then let the parts alone for about ten days. In the 
very young, robust patient, the sutures may be removed on 
the tenth or twelfth day ; but with those not very strong the 
stitches better be allowed to remain fourteen or sixteen days. 
The bowels may, however, be moved on the eighth day, 
as a rule. 

Dressings and Local Applications. — Regarding these, we 
say, none are required. Cases do better without than with 
them. 

Removal of the Sutures.— The patient may lie upon her 
right side, with her thighs well flexed. We now pass the 
index finger of the left hand into the vagina, and feel for the 
highest suture. Having found it, we slip Cutler's suture 
forceps and cutter alongside the finger, and introduce the 
probe point of the long blade under it, and then open the 
blades a little, and pass the forceps in about a half inch 
further, taking care that the forceps are a little to the right 
of the twist of the suture. Now press the forceps together, 
and we sever the wire and hold the suture firmly; gently 
lift the forceps, and remove the suture. Remove the next 
below in the same manner, till all are removed. 

We next proceed to cut the loops of the sutures in the 
perineum, if we have used the quill suture ; and after remov- 
ing the piece of bougie straighten out the wire which has 
been curved around it. We then make gentle traction upon 
the opposite ends of the sutures, sufficiently to allow us to 
remove the other piece of bougie. Now seize the twisted end 
of the sutures, one at a time, commencing with the one at 
the margin of the anus, and withdraw them, making counter 
pressure against the perineum at their point of insertion as 
each is withdrawn. We may now gently apply a pad of lint 
against the perineum, and support it with a T bandage. For 
a week longer the patient should keep the knees together 
religiously, and the T bandage and gentle compress may well 
be used for several weeks. The movements of the bowels 



LACERATION OF THE PERINEUM. 641 

may be assisted by injections of warm water and soap for 
several weeks. 

When shall we place Sutures in the Recent Laceration 
of the Perineum? — I would say as a rule, when the lacera- 
tion is extensive, place silver wire sutures in the parts at 
once — i. e., within a day or so. No freshening of the edges 
of the wound is then needed. Those lacerations which are 
slight may be expected to unite without using sutures, if we 
keep the limbs together, and use the precautions already 
mentioned. In the recent case the sutures need not remain 
more than eight or nine days. 

Remedies. 

Remedies are sometimes not needed at all; in some in- 
stances, however, symptoms arise which demand their use, and 
they should be given as homoeopathically indicated. Arnica, 
Hamamelis, Aconite, Bell., Ars., Nux, or Cal. will be most 
frequently demanded. Opium, given to constipate the bow T - 
els during the first eight days after the operation, w 7 e recom- 
mend, not as a remedy in the doses suggested, but rather to 
induce an abnormal condition. We give it in Tr., not to 
relieve pain or cure disease, but to restrain the normal peris- 
taltic action of the bowels. If the patient has some idiosyn- 
crasy regarding food, so that she knows of some food which 
will, in her case, cause an arrest of action of the bowels, let 
her have it instead of Opium, by all means. 

Aconite is indicated if inflammatory fever is manifested. 

Arnica will ordinarily relieve any pain complained of in 
these cases. 

Nux or Ars. may relieve nervous symptoms, according to 
their pathogenesis, as laid down in works upon materia medica. 

41 



642 EATON ON DISEASES OF WOMEN. 



CHAPTER LIV. 

EXTRA - UTERINE G ES TA TION. 

The development of a foetus in the Fallopian tube or 
abdominal cavity is termed extra-uterine gestation or preg- 
nancy. The lodgment and impregnation of an ovum in the 
tube is one of those freaks of nature about which we may 
theorize to our heart's content, and know as little afterwards 
as at first. The fact, however, is presented, that gestation 
does commence in the tube in some instances. That it never 
goes on to completion there is just as true. The distension 
of the tube by the foetus generally causes a rupture of its 
coats about the third month. Barnes claims that this rupture 
of the tube is not necessarily fatal, and that an abdominal 
gestation is sometimes the result. Other authors are agreed, 
so far as I have noticed, that the rupture of the Fallopian 
tube is fatal. Few can say they have ever seen it otherwise. 

Abdominal gestation may, however, become attached to 
any part of the peritonseal cavity, and go on to the full 
development of the child. The interest in this class of cases 
is found in' the methods of nature and art adopted in its deliv- 
ery, and also in the fact that it may remain in the abdomen 
for years, without producing any perceptible effect upon the 
mother. One case is recorded where the child remained in 
the abdomen fifty-six years.* Campbell f collected reports 
of eighty-five cases of abdominal gestations, varying in time 
from four to fifty years. (This does not look as if there 
was any very great necessity for operative interference.) 

In some cases uterine pregnancy commences and goes on 
to completion, while abdominal pregnancy exists in the same 
woman. 

* Barnes's " Diseases of Women," p. 322. t Ibid., p. 322. 



EXTRA -UTERINE GESTATION. 648 

Generally the death of the child takes place, it is said, 
at about the time of the completion of full term, if not then 
delivered. This I have some reason to doubt, from havino- 
seen one in Rush Medical College Museum, which had been 
removed, by abdominal section, three and one-half years from 
the time of conception, which had an appearance of much 
greater age than nine months. I could not learn the history 
of the case, however. 

Interstitial, or intra-mural, gestation, as it is sometimes 
called, consists of the development of a foetus at the uterine 
extremity of the Fallopian tube, which makes for itself a de- 
pression in the muscular fibers of the uterus around the tube. 
This form of abnormal gestation is about as fatal as the reg- 
ular tubal variety, sometimes producing sudden death from 
rupture of the tube or the outer coats of the uterus, or being 
fatal from ulcerative action implicating the rectum or perito- 
naeum. In these cases gestation sometimes goes on to full 
term ; but more frequently the foetus dies sooner, and may 
remain undecomposed for a time, when it disintegrates, and 
is discharged piecemeal by the uterus, vagina, or rectum, or 
through fistulous openings in the abdominal walls. 

Diagnosis. 

In all varieties of extra-uterine gestation the symptoms 
are more or less obscure for a few months after impregnation. 
The uterus, of course, enlarges little, or none at all; and still 
there is present, in most cases, partial or complete arrest of the 
catamenia, together with some nausea; enlargement of the 
papillae around the nipples; some darkening of the skin in 
this locality; enlargement of the breasts, etc. In tubal and 
intra-mural pregnancy there is considerable pain and soreness 
in one iliac region. At times some enlargement may be felt 
here; at other times the tube may be felt enlarged by rectal 
explorations; still, similar symptoms sometimes arise from ova- 
ritis or salpingitis, with amenorrhoea, and from other diseases 



644 EA TON ON DISEASES OF WOMEN. 

of the uterus and its appendages. In the case of abdominal 
gestation the symptoms are still more perplexing for a time, 
as for several months, and in some instances during the entire 
history of the case, menstruation goes on uninterruptedly. 
After three or four months, however, we may detect the pul- 
sations of the foetal heart, and this fact, taken in connection 
with the normal size of the uterus when unimpregnated, to- 
gether with the absence of the severe pain experienced from 
intra-mural pregnancy, and from the patient's henlth being 
very little affected, will determine the diagnosis in favor of 
abdominal pregnancy. 

Prognosis and Treatment. 

But little can be done in these cases in the way of treat- 
ment. They are noted here for the general information of the 
student, and particularly to aid him in making a diagnosis of 
other ailments. The patient is likely to die in about three 
months after the commencement of tubal, and in from three to 
six months' duration of interstitial gestation. Kussmaul 
collected thirteen cases of tubal pregnancies, all of whom 
died before the sixth month. Rosenmuller * reports one case 
where the sac burst at five months from interstitial impreg- 
nation. 

In abdominal gestation it is best to advise caution 
aJbout becoming again pregnant, as this event (when the full 
term is accomplished in the uterus), and labor sets in, is very 
liable to destroy the patient by inducing a rupture of the sac 
in the aMomen, thereby causing a necessity for Ciesarian 
section, for the removal of the foetus in the abdomen, which 
in the delicate condition of the patient is liable to prove fatal, 
;is it is sure to do if the foetus is left in the abdominal cavity 
after the amniotic sac has been ruptured. 

Our hands are quite completely tied in these cases of ab- 
dominal gestations, where there is no special urgency, from 

* Monatsschrif t fur Geburtskunde, 1862. 



EXTRA- UTERINE GESTATION. 645 

the experience, which I have mentioned, of the long life 
enjoyed by some women, though carrying an abdominal preg- 
nancy. Symptoms may be met with appropriate, clearly in- 
dicated, homoeopathic remedies; and exercising great care 
that the sac be not ruptured, is giving our patient the best 
chance for life. 

In case the sac becomes inflamed for any reason, adhesions 
may form between it and the abdominal walls, and a sinus 
may form externally through these tissues. In this case it is 
proper to enlarge the opening, and extract the foetus; inject 
the sac with a diluted Solution of Iodine, after ligating the 
funis near its placental attachment with catgut ligature, and 
removing the cord, leaving the placenta in the abdomen. 
Then compress the abdomen with bandages to bring the 
walls of the sac in contact, and promote union, leaving the 
external opening clear, to allow of the discharge of matter till 
the sac is healed. A similar procedure is advisable when the 
abscess in the sac points in the vagina. When the ulceration 
points into the uterus, in intra-mural gestation, we may en- 
large the os uteri by the use of sponge tents till we can 
extract the foetus in pieces "through it, using the vulsellum 
forceps to extract such parts as we are able to reach. This 
treatment may sometimes avail, especially if there is a large 
laceration of the internal wall of the sac. 



646 EATON ON DISEASES OF WOMEN. 



CHAPTER LV. 

STRANGURY, DYSURIA, ISCHURIA, RETENTION OF URINE, SUP- 
PRESSION OF URINE, ENURESIS, ETC. 

Strangury, Dysuria, Ischuria, etc., are terms used to sig- 
nify a complete or partial retention of urine in the bladder and 
painful evacuation of it ; while suppression of urine indicates 
the failure of its secretion in the kidneys. These affections 
are found in the male as well as the female; hut there are 
certain causes which operate only in the female to produce 
this condition, and it is these only which we purpose to dis- 
cuss here. 

Etiology. 

Displacements of the uterus, which cause the organ to 
press the urethra tightly against the pubis, as in retroversion, 
ante-version with some degree of prolapse, ante-flexion, etc., 
cause painful micturition. These displacements not only 
cause strangury from pressure, but from the irritation of the 
urethra caused from the pressure. After confinement wo- 
men are often troubled with retention, which in some instances 
results from irritation produced by the pressure of the child's 
head against the urethra for a long time, in its passage 
through the pelvis ; and sometimes from a semi-paralyzed 
condition of the muscular fibers of the bladder, rendering it 
incapable of contraction. This is increased by over disten- 
sion, liable to result from a neglect to have it evacuated in 
due time. Suppression of urine results from want of healthy 
action in the kidneys, or from obstruction in the ureters; 
but I can not discuss these conditions here. 



DYSURIA, AND SUPPRESSION OF URINE. 647 

Diagnosis. 

The physician is sometimes misled by the patient's state- 
ment that she passes water very often. The distended con- 
dition of the bladder causes a desire to frequently urinate, 
as does also the pressure of the displaced uterus against the 
urethra; but the frequent passing of a few drops of urine, 
instead of being evidence that the bladder is empty, is very 
conclusive evidence that it is full or inflamed. Let the 
student be impressed with this point in diagnosis, as the 
patient is very liable to view the case as excessive rather than 
diminished flow of urine. These symptoms may be present 
when there is no large amount of urine in the bladder, from 
the constant irritation of the urethra, by a displaced uterus, 
or improper adjustment of a vaginal pessary ; and hence the 
introduction of the catheter is demanded to clearly settle the 
diagnosis. The distended bladder may usually be felt above 
the pubis in the hypogastric region; but enlargement here 
may be due to ascites, tympanites, an enlarged uterus, uterine 
or ovarian tumors, etc. ; hence this symptom is not conclu- 
sive of retention of urine in the bladder. 

The sufferings of the patient from ischuria are sometimes 
very intense. The patient will make frequent and long pro- 
tracted attempts to urinate, and strain with her utmost 
power, and still get no relief from the discharge of the few 
drops of urine she is able to force away. After confinement 
the pain is not so great, usually, owing to a degree of in- 
sensibility of the parts ; still its retention must not be over- 
looked. If urine is not passed freely, the catheter should be 
used to make sure the bladder does not become over dis- 
tended. 

Prognosis. 

Death is the prognosis if the patient gets no relief from 
retention. But with some skill in the diagnosis as well as in 
the treatment (so that there is not too great a loss of time) 



648 EA TON ON DISEASES OE WOMEN. 

we may hope to be successful in the treatment. In ischuria 
not dependent upon chronic cystitis we may hope to cure 
speedily. (See chapter on Cystitis for treatment of dysuria 
caused by this disease.) 

Treatment. 

The first point in treatment is to promptly evacuate the 
bladder with the catheter. Secondly, replace the uterus if it 
be displaced, or remove an offending vaginal pessary if one 
is there. Cantharides 6 X is usually the indicated remedy. 
Sometimes Aconite, Bell., Can. ind., Cub., etc., are the indi- 
cated remedies. 

There is very little use to depend upon remedies alone, 
when the cause is left to act. First remove the cause, and 
then remedies may cure the symptoms. Most cases are 
cured promptly with homoeopathic remedies (after the cause 
has been removed). The cure may not be instantaneous, 
however; hence, for a few days it may be necessary to 
artificially evacuate the bladder with the catheter twice a 
day. Here Nux vom. 2 X or 3 X is the remedy most frequently 
indicated. If there has been great loss of blood during de- 
livery or subsequent to it, China 3 X is indicated. I do not 
mean "give one dose and wait four weeks for it to act," but I 
mean to repeat it every three or four hours. Canthar., Puis., 
Merc, Helleb., Dulc., or Ars. alb., may sometimes be indicated. 
(See Materia Medica for special indications.) 

Enuresis. 

Enuresis, or want of power to restrain the flow of urine, 
is quite the opposite to dysuria, or strangury. In this com- 
plaint the urine passes involuntarily, not only during sleep, 
but while the patient is awake, in some cases. Here, as in 
dysuria, I intend simply to consider some causes of the com- 
plaint which are peculiar to women ; the main ones of which 
are, pressure upon the bladder from the gravid uterus, when 



ENURESIS. 649 

approaching full term, and pressure from the enlarged uterus 
resulting from tumors of the organ or from tumors of the 
ovaries. From these causes the muscular fibers at the base 
of the bladder seem to have lost their tonicity, and hence 
results the inability to retain the urine. Want of room for 
the bladder to become distended, on account of these causes, 
is also an element in the case. Catarrh of the vulva, vagina, 
or urethra sometimes causes this condition in girls. 

Treatment. 

The indication is clear to remove the pressure from the 
bladder as much as possible. This is many times very suc- 
cessfully accomplished with the abdominal supporter. The 
reclining position, in some cases, relieves temporarily in some 
measure. Together with these measures the following reme- 
dies may be studied and prescribed according to their homoe- 
opathic indications : Canst., Rhus, Nux, Bell, Sulph., Sepia, 
Aeon., Bry., Hyosc, Canth., etc. 



650 EATON ON DISEASES OF WOMEN. 



CHAPTER LVI. 

GONORRHOEA IN WOMEN. 

It seems, from the earliest accounts which have been re- 
corded, that gonorrhoea has always existed among all nations. 
Moses speaks of it in the Bible* as "a running issue out of 
the flesh." Hippocrates, Herodotus, Celsus, and Cicero speak 
of the disease. It is treated of especially in works upon 
venereal diseases ; but it seems to me advisable to mention 
it here, as the peace of families may at times depend upon 
the physician's correct understanding of it. Many physi- 
cians even to-day believe that gonorrhoea arises only from 
infection, which is a serious error, and liable to cause blame to 
rest upon the innocent. 

Ktiology. 

Gonorrhoea may arise from infection ; that is, from connec- 
tion with a man affected with the disease, or from the appli- 
cation of the gonorrhoeal matter to the mucous membrane of 
the labia or vagina with the finger or otherwise. It may also 
develop from a cold, causing inflammation in the vagina and 
urethra, which is followed by a discharge of matter which will 
produce the disease in the male. Excessive coitus, want of 
cleanliness, etc., may also develop the disease. Women may 
also disease a man, who are themselves free from any symp- 
tom of the disease, and who have never before had any sexual 
intercourse. This is asserted by Diday.f Fournier,J from 
his investigations coincides with these views. Out of three 
hundred and eighty-seven cases of gonorrhoea in men, he 

* Leviticus, chapter XV. 

t Bumstead on Venereal Diseases, page 50. % Ibid. 



GONORRHCEA IN WOMEN. 651 

found that it had been contracted from the following classes 

of women : 

From women of the town 12 

Clandestine prostitutes 44 

Kept women, actresses, etc 138 

Working girls 126 

Domestics 41 

Married women 26 

661 

Excessive acidity of the vaginal secretions may cause 
the disease in a man, or at least produce a condition which 
can not be clearly diagnosed from the disease arising from 
contact with an undoubted case of purulent gonorrhoeal mat- 
ter in the woman of the town. Sexual intercourse during, 
just before, or just after the menstrual, period, may disease 
the husband; and still we can not say the wife has gonorrhoea 
in these instances. We would be doing her gross injustice 
in the eyes of the people by such an assertion. 

We must pay respect to the popular opinion, which is 
well settled, that gonorrhoea only arises from an impure con- 
nection. We are obliged, therefore, to diagnose the case 
as leucorrhoea, and explain that gonorrhoea may be con- 
tracted by the husband from connection with his wife while 
suffering from some varieties of leucorrhoea (or whites), Or 
at the menstrual period, and in some instances from the 
acrid secretions of the uterus and vagina, when nothing ab- 
normal can be discovered in the female genital organs by 
physical examination. Dr. Bumstead* fully agrees Avith 
these views, and says "he is convinced by extended obser- 
vation that gonorrhoea originating in this mode is of very 
frequent occurrence." 

Symptoms. 

In the female the symptoms of gonorrhoea are less vio- 
lent than in the male. Inflammation, heat, swelling, itching, 

*Bumstead on "Venereal Diseases," p. 46. 



652 EATON ON DISEASES OF WOMEN. 

burning, etc., in the labia, vagina and urethra, with painful 
micturition, and a discharge of purulent matter, are the symp- 
toms produced by the disease when contracted from infec- 
tion. When contracted from want of cleanliness, there is less 
discomfort in every way; but the discharge is sometimes large, 
at other times small in amount. The attack comes on gradu- 
ally from this cause, while in the case arising from infection, 
the symptoms come on in about five days after exposure, 
and are of an active character, causing sometimes so much 
swelling of the labia as to make walking almost impossible. 
Swelling of the inguinal glands often accompanies this form 
of the disease. Abscess of these glands is liable to occur, but 
no constitutional blood taint is likely ever to be manifested. 
In some cases thg labia are mainly affected, in others the 
vagina, and in some the vagina and urethra, while in others 
the urethra, vagina, and labia are all simultaneously affected. 
The gonorrhceal discharge is thick, whitish, and slightly puru- 
lent, sometimes streaked with blood; but it has no character- 
istic qualities, either chemical or otherwise, excepting its 
infectious properties, which characterize it from leucorrhcea. 

Treatment. 

Where the urethra is mainly affected, causing much pain 
in this canal during micturition, Can. ind., Aconite, Ciibebs, 
Canthar., Merc, Sepia, or Ars. will usually give prompt re- 
lief, if used according to their homoeopathic indications. 
Where the labia and vagina are affected, without the urethra 
being implicated, bathing the parts with a Solution of Kali , 
chlo. every four hours, previously washing away the dis- 
charge with warm water and castile soap, is often all the 
treatment required. In some obstinate cases, the vagina and 
labia should be well and frequently coated wdth Vaseline, and 
the vagina should be swabbed out with : Zinci sulph., 10 grs\ 
to the oz. Using a speculum, and putting the vaginal walls 
upon the stretch, we saturate a soft sponge with the wash, 



GONORRHCEA IN WOMEN. 653 

and bathe the vaginal membrane freely, repeating this treat- 
ment every day for a week or so, when we will usually find 
the discharge has ceased, it having previously been kept up 
from the folds of vaginal membrane concealing surfaces 
which were affected, and still not reached until we dis- 
tended the vagina with the speculum. The warm sitz bath 
is a useful adjuvant in the treatment of these cases. 

Enlargement of the inguinal glands, called bubo, should 
be treated with warm compresses of cloths wrung out of 
warm water, or warm hop water, or we may add Tr. of Ar- 
nica to the water. Diluted Spts. of Camph. may be bathed 
over the swelling three times a day. If a few days' treat- 
ment of this kind fails to cause resolution, in connection 
with the internal use of the indicated remedy, we may poul- 
tice with ground flaxseed meal, or pulv. slippery elm, apply- 
ing the poultices warm, and renewing them every six hours. 
If pus forms, the abscess should be lanced freely, the matter 
evacuated, and poultices continued. Aconite, Sepia, Sulph., 
Merc, loo 7 ., Ars., etc., are usually the indicated remedies. 
(See Materia Meclica.) 

Those cases about which we are in doubt as to the real 
nature of the disease, though manifesting symptoms giving a 
suspicion of gonorrhoea, we had better name to the patient 
and friends as leucorrhcea, or vaginitis (if you like), and then 
proceed to treat the case for gonorrhoea. Of course, where 
the history of the case and the violence of the symptoms 
clearly indicate it to be gonorrhoea, and there is no need of 
concealment, the physician should, of course, frankly state 
the nature of the disease. In either condition of affairs 
sexual congress should be strictly forbidden, and the patient 
should be warned to use care nor to get the matter carelessly 
upon other mucous surfaces, especially in the eye. 

Gonorrhoea in Young Girls. — When quite young girls be- 
come diseased in this way (through the intent of some angry, 
low-lived servant girl, in order to spite the family for some 



654 EATON ON DISEASES OF WOMEN. 

* 

fancied indignity or insult), or from any other cause, the wash 
\ of Kali chlo. should be injected into the vagina with a small 
tubed syringe, and the external genitalia should be freely 
bathed with the same three times daily. Vaseline may also 
be applied to the mucous surfaces of the labia; and when 
the urethra is affected the same internal remedies should be 
used, as mentioned in connection with the treatment of 
gonorrhoea in women. 



SYPHILIS IN WOMEN. 655 



CHAPTER LVII. 

SYPHILIS IN WOMEN. 

Syphilis has only been known (so far as we can trace its 
history) about four hundred and eighty-five years. In the 
latter part of the fifteenth century, about the year 1495, it is 
described as being prevalent in France, Italy, and Germany, 
since which time the world has not ceased to suffer from its 
effects, until at the present time we have hard work to follow 
it in all its contaminating effects in the blood of nearly the 
entire race. 

The immediate effects of primary syphilis are not so ap- 
parent now as in its past history, but its remote effects are 
around us on every hand. We do not intend to make more 
than a very few suggestions regarding syphilis, which appear 
to us to be of special interest to the student, leaving him to 
study the disease more in detail from special Avorks on " Vene- 
real Diseases." 

Etiology. 

Syphilis is contracted from infection and through hered- 
itary descent. In its primary form it is communicable by 
means of copulation, or from the application of the syphilitic 
virus to any irritated mucous or cutaneous surface, where it 
develops as a chancre or chancroid. 

A person having secondary syphilis, as it is called (mucous 
patches in the mouth, throat, etc.), may communicate the dis- 
ease to another by "kissing; and the disease develops in such 
person as a primary sore at the point where the virus entered 
the system. Tertiary symptoms are communicated only 
through the semen or ovum. Tertiary syphilis may develop 
from the semen in a child begotten of a father so affected, 



656 EATON ON DISEASES OF WOMEN. 

and the mother may become affected with the disease in its 
tertiary form, in this manner, so far as the cutaneous symp- 
toms are concerned. 

I am sure I have seen the primary form developed from 
the virus rubbed off from the seat of a water-closet. I was 
formerly skeptical about this method of infection, but am now 
fully convinced such may be the fact. I will give one case 
in illustration. 

A young man came to me with a well developed Hun- 
terian chancre upon the dorsum of the penis, about three 
inches from the glans. He had previously been a patient 
of mine with other diseases, gonorrhoea among the number, 
and I am confident he would tell me the truth, as he was no 
ways backward about telling of his liasons. He declared that 
he had had no sexual intercourse for more than two months, 
that the sore commenced about a week before I saw him, and 
that a domestic where he lived, he had reason to believe, had 
the disease. He could not credit my diagnosis that it was 
a chancre, and he neglected treating himself properly till 
finally convinced by his inability to cure himself, when he 
again came to me. I then treated him as well as I could. 
He thought himself cured, and married. His first child was 
still-born, and covered with syphilitic eruptions. His wife 
now manifested the disease clearly in its tertiary form. (She 
had never had primary syphilis.) 

This case convinced me that the disease in a primary 
form could be contracted without copulation. Since that 
time, which was some sixteen years ago, I have seen a num- 
ber of cases, both in the male and female, which have proven 
more strongly this idea to be correct. 

The virus will not, however, be readily absorbed by any 
surface which is perfectly intact. Some irritation of the 
mucous or cutaneous surfaces is necessary for its absorption, 
unless it b,e allowed to remain in contact with the skin or 
mucous membrane for a considerable length of time. 



SYPHILIS IX WOMEN. 657 

A syphilitic child may communicate the disease in its 
secondary form to a healthy wet nurse through nursing, and 
the diseased wet nurse may communicate the disease to the 
healthy child she may be employed to nourish. 

Symptoms and Diagnosis. 

The syphilitic symptoms are not so marked or violent as 
are those of gonorrhoea.. The period of incubation for the 
chancroid sore is about eight to ten days, while the Hun- 
terian chancre will not be found under about eighteen days 
after exposure. 

The first symptom in the case is the appearance of a 
little pimple, slightly elevated, upon the inner surface of one 
labia, or at the juncture of the labia minora with the labia 
majora. This pimple slowly suppurates, and in about three 
days becomes an open sore, not, however, very painful. A 
hard margin and base is now r observed, and the ulcer grad- 
ually enlarges. This is the Hunterian variety of chancre, and 
is usually single, though occasionally multiple. The chancroid 
is manifested in multiple sores, which spread and multiply 
rapidly, but do not ulcerate so deeply, and have a soft margin 
and base. 

From these ulcerated surfaces a considerable quantity of 
matter is discharged. The sores are situated upon the inter- 
nal surface of the labia, and sometimes within the vagina, 
and even upon the cervix uteri. We can not, therefore, de- 
cide that the patient has not syphilis because we find no 
chancres upon the internal surface of the labia or around the 
margin of the os vaginam. We must thoroughly examine the 
cervix uteri and vagina, by the aid of a. speculum, in all sus- 
pected cases before giving a positive diagnosis. 

Buboes, or enlargement of the inguinal glands, occur in 
connection with syphilis more frequently than in cases of 
gonorrhoea. 

The above are considered ordinary primary symptoms. 

42 



658 EATON ON DISEASES OF WOMEN. 

The location of the chancre may, however, vary. The pres- 
ence of a chancre in some place is necessary, however, to the 
diagnosis of a case of primary syphilis. 

Secondary syphilis is the secondary manifestation of the 
disease, after the cure of, or in connection with, the primary 
ones. It is manifested by mucous patches, and eruptions on 
the skin, which are usually shiny and yellow. Condylomata, 
which consist of ear-like growths about the external gen- 
italia, upon the mucous and cutaneous surfaces, etc., are an- 
other form of development of secondary syphilis. 

Tertiary syphilis affects the osseous structure, especially 
the tibia and nasal bones, as well as causes various forms of 
eruptions on the cutaneous surface. (See works on Venereal 
Diseases.) Secondary symptoms are seldom manifested after 
the chancroid or soft chancre; but no patient is safe from 
them after having had the Hunterian variety. 

Treatment. 

The treatment of syphilis in women does not materially 
differ from the treatment of this disease in the male. We 
have mentioned the disease here mainly to call attention to 
its transmissibility through nursing and the spermatozoa in 
impregnation, and to suggest the necessity for thorough 
exploration in suspected cases that chancres be not over- 
looked. The treatment of primary syphilis has usually been 
more heroic than wise, both in the male and female. 

Our treatment consists in first giving Merc. sol. 3 X , a 3 gr. 
powder, every three hours, and bathing the chancre with a 
weak solution of carbolic acid. After three days change the 
local application to Vaseline in case of chancroid, and give 
Merc. sol. and Ars. alb. in alternation every three hours, 
which is usually all the treatment required. In some in- 
stances I have used Basilicon ointment, instead of Vaseline, 
with the happiest effect. 

In the case of the Hunterian chancre, after using the 



SYPHILIS IN WOMEN. 659 

treatment suggested for three or four days, it is best to make 
one application of fuming, Acid nit. with a glass rod, taking 
care that it touch the entire margin and base of the chancre 
sufficiently to cause a free slough of the indurated tissues ; 
then dress with Vaseline. In case the single application of 
Acid nit. does not produce a slough, another application 
should be made. We prefer that Merc, be taken three clays 
before we attempt to cause the slough, in order that the 
healing after the slough may be more prompt. After the 
slough has separated we have a simple sore to deal with, 
which will readily heal if the syphilitic poison has been 
neutralized by remedies as suggested. 

In cases which manifest secondary symptoms, as the 
mucous patches in the mouth, condylomata, pustules of the 
skin, or the yellow shiny spots upon the skin. Kali wd. 7 
Merc, cor., Ars., Acid nit., Thuja, etc., are the remedies ordi- 
narily indicated. 

Tertiary symptoms are to be treated quite similarly to 
the secondary, Thuja being the most prominent remedy. 
Silicia, Cat. carb., etc., I would add to the list of remedies 
in treating this form of syphilis. 

Bjiboes in syphilis are to be treated the same as when 
occurring in cases of gonorrhoea, to which the student is re- 
ferred in order to save repetition here. 

The mucous patches and condylomata require no local 
treatment, save that which conduces to cleanliness. The 
remedies suggested for the secondary form of syphilis are 
adequate to cure them. Frequent bathing of them with 
tepid water and castile soap, when the patches are around 
the anus or vulva, and washing the mouth with a weak solu- 
tion of salt or Potass, chlo., is well enough, when the lips, 
cheeks, throat, or gums are affected. 



660 EA TON ON DISEASES OF WOMEN. 



CHAPTER LVIII. 

DISEASES AND DIFFICULTIES OF PREGNANCY. 

The development of the foetus in the uterus produces in 
some women considerable disturbance of the general system, 
as well as particular affections of special organs and func- 
tions. The uterus, when affected with inflammation or dis- 
ease, produces through the sympathetic nervous system 
many symptoms in remote parts of the body, which have 
been treated of under the head of "sympathetic affections." 

The pregnant state, being one physiological in its char- 
acter, it would seem, should produce no serious effects on the 
female system. We would naturally expect that this process 
might go on to completion of term without any interference 
with the general health, as we see among the animal creation. 
This is observed in some cases in the human female, notably 
among those savage or half-civilized races who live in the 
open air, perform much physical labor, and live upon the 
plainest diet, and in all things allow nature's inclinations and 
appetites full sway, almost like the beasts of the field. But 
as we rise in the scale of civilization we find that the women 
suffer more in the process of gestation and labor. 

The want of physical exercise and pure air in. sufficient 
quantity to develop and maintain the full normal amount of 
nerve and muscular strength tends to the production of ail- 
ments which, under circumstances of conformity to nature's 
laws, might be avoided. The tight lacing of the body of 
ladies in civilized and cultivated society, with the late hours 
spent in the heated and ill-ventilated ball-room, the insuffi- 
cient clothing worn, and the nervous exhaustion consequent 
upon the rounds of dissipation engaged in by many, tend to 



DISEASES AND DIFFICULTIES OF PREGNANCY. 661 

unfit woman for her high function in propagating the race; 
thus entailing upon her offspring debility and disease, and 
causing herself untold agony in the process, that should be as 
free from pain and disturbance as it is natural in itself 

But we have to take the world as it is, and the people 
likewise; and as it is probable that we will have more pa- 
tients among the civilized races than the savage, we will 
probably have to contend with ailments innumerable accom- 
panying the pregnant condition, for we can not expect to 
effect a reform in women's habits, dress, and diet in our natural 
lifetime, though it is to be hoped that the world will some- 
time pay more attention to the health of women than it does 
to-day, not by a return to barbarism and laying upon women 
grievous, severe physical labor, greater than she can well 
bear, and which is inconsistent with any mental growth, nor 
by set rules of living, bathing, and diet (for what is good for 
one may not be for another), but in the avoidance of excesses, 
by greater freedom from conventionalities, by plainer living, 
by conforming to the necessary laws of development and 
growth in girlhood, stopping the demand of society that 
young girls shall be expected to dress, act, and live like 
ladies, etc. 

Various Symptoms. 

One of the first symptoms of disturbance in the system 
during gestation is nausea — sometimes this is severe, and 
causes the rejection of nearly the entire ingesta. (See Vom- 
iting in Pregnancy.) 

Coincident with nausea we have the frequent desire to 
pass urine caused by the pressure of the enlarged womb 
irritating the urethra as it passes posterior to the pubis. 
Again we have constipation, resulting from the pressure of 
the uterus against the rectum. Sometimes diarrhea sets in, 
indicating an inflamed condition of the rectum, produced by 
the irritation of the enlarged uterus. 

Along with these symptoms Ave have frequently headache, 



662 EATON ON DISEASES OF WOMEN. 

toothache, and neuralgia in various parts of the body, with 
a fretful disposition, various abnormal cravings for indigest- 
ible substances, such as slate pencils, lime, pieces of wood, 
etc., etc., ad infinitum. 

As time rolls on the uterus still increases in size. It 
presses upon the bowels, liver, stomach, etc., and we have 
derangement of digestion, the sou?' stomach, gastralgia, heart- 
burn, pruritus vulvae, and a miserable condition generally. 
Very little consideration is often exercised towards patients 
in this condition, the treatment shown them being calcu- 
lated to irritate and anger them, and the effect is manifested 
in the bad temper of the child when born. 

Albuminuria is a frequent condition of pregnancy, and 
was formerly supposed to result from disease of the kidney, 
the exact nature of which was in dispute ; but it is now 
conceded that albumen is frequently in the urine of pregnant 
women in the later months of pregnancy, and is caused by 
the pressure of the gravid uterus upon the renal vessels, 
and that as soon as the pressure is removed by the delivery 
of the child the albumen will generally cease to be found in 
the urine. 

Urwmia, caused from the same pressure, sometimes re- 
sults, and it is mainly from this cause that we have convul- 
sions in these cases, though, of course, the irritable condition 
of the general nervous system tends to produce convulsions, 
and may exist without the uraemia being present; still, as I 
said before, this I believe to be the most frequent cause of 
convulsions occurring in the pregnant woman. 

Cramps in the thighs and calves of the legs, varicose 
veins of the limbs, cedematous swelling of the lower limbs, 
and sometimes general anasarca, jaundice, hemorrhoids, etc., 
are sometimes produced by the pressure of the enlarged 
womb upon the nerves and blood-vessels in the pelvis and 
abdomen. Palpitation of the heart from reflex nerve action, 
as well as general fever, sometimes result. 



DISEASES AND DIFFICULTIES OF PREGNANCY. 663 

Displacements of the uterus are common in the early 
months of gestation, notably prolapse. This is owing to its 
increased size and weight causing it to settle down in the 
pelvis ; and in our opinion the organ thus prolapsed produces, 
not only the symptoms heretofore noted as the result of 
pressure, but also, through the sympathetic nerve ganglia, 
causes the nausea on first rising in the morning. If this 
theory be correct we have a hint of the means of relief, 
which, so far as I have tried them, have been successful. I 
refer to restoring and maintaining the position of the uterus 
in situ. 

Retro-version of the uterus sometimes takes place during 
the first two or three months of gestation, and is generally 
the result of jumping out of bed, or from a carriage, or in 
some way receiving a severe jolt. In this case the symptoms 
of misplacement are well marked, come on suddenly and 
violently, and unless soon relieved will result in the death 
of mother or child or both. Therefore, when called to a case 
where symptoms of displacement are manifest, with the as- 
surance of pregnancy being present, no time should be lost 
in making a physical examination. If retro-version is present 
the introduction of the finger into the vagina will generally 
reveal the presence in the vagina of a large globular body, 
consisting of the body of the uterus; and by passing the 
finger high up on the anterior wall of the vagina we discover 
the os uteri. Replacement of the organ is, of course, at 
once indicated. This is the only efficient method of obtain- 
ing relief from the distress experienced in these cases where 
retro-version is present. 

Syncope is often a resultant symptom of this condition. 
The student will also beafm mind that hemorrhage from the 
uterus may result in the pregnant woman from partial sep- 
aration of the placental attachment, or in placenta previa, 
and be in readiness to use those prompt measures for its 
suppression which are often absolutely necessary to the saving 



664 EATON ON DISEASES OF WOMEN. 

of life. I will only notice pruritus vulvae and leucorrhoea as 
sometimes annoying the patient, resulting from a cervical 
inflammation, generally combined with some vaginitis, the 
leucorrhoea being dependent upon this irritation, and its acrid 
character causing the itching of the labia and vagina. This 
affection is often concealed from the physician by the patient 
through feelings of modesty, and she sometimes injures her- 
self in her efforts to relieve the itching. Swelling and in- 
flammation of the mammary glands in some instances have 
their predisposing cause in the pregnant state. 

Treatment. 

Although the recital of the many ailments of the pregnant 
state seems formidable we may hope to relieve many of 
them — though it is sometimes impossible to relieve them all; 
and we will have need of using constant vigilance, and in some 
instances continuous treatment, to obtain satisfactory relief 
(if relief may be considered satisfactory that requires con- 
stant application of treatment). The size of the uterus, 
which does so much to produce these derangements, can not, 
of course, be modified ; neither can the supersensitive nerv- 
ous system be restored in many cases. 

It is quite common that the womb is morbidly sensitive 
during the early months of gestation. This may be due in 
part to the displaced condition of the organ, owing to its in- 
crease of size and weight, and in part to the irritability of 
the organ, consequent upon the growth of its substance, ne- 
cessitated by nature, in order that it may contain and nourish 
the foetus. 

These considerations furnish to my mind reasons sufficient 
to cause me to believe that it is best to rely in part upon an 
attempt to relieve the uterus as much as possible from all 
pressure from the superincumbent weight of the abdominal 
organs, and in restoring and maintaining it in its normal posi- 
tion in the pelvis, instead of depending upon remedies alone 



DISEASES AND DIFFICULTIES OF PREGNANCY. 665 

for the relief of the symptoms resulting from the condition 
of the organ in the earlier months of pregnancy. 

This is obtained by rest in the reclining posture, with 
the occasional lifting up of the uterus by digital taxis. Lying 
with the hips a little elevated, with the limbs separated, is 
the best position. This favors the ingress of air into the 
vagina, and relieves the uterus from pressure from the Aveight 
of the bowels. When this position can be maintained for a 
period of some weeks we will have little trouble with the 
case as a rule; but as it is very unusual that a patient is 
willing to submit to this confinement, and as we have the 
injurious effect of want of exercise to contend with, if we 
allow it, we are driven to other expedients to accomplish the 
same ends. 

I have found that the use of an elastic abdominal sup- 
porter accomplished the purpose in many cases (see Plate 
XII) ; some, however, requiring that the recumbent posture 
be taken for an hour or two after dinner, and applying the 
supporter before rising. We should be careful that it is of 
the right size, and is applied so as to lift the abdomen and 
not compress it, It is necessary that the band be a little 
tight in the lower part of the abdomen and loose above, so 
that the abdominal regions be supported by it, I have had 
made by Max Wocher & Son, of Cincinnati, a modification 
of the London supporter (see chapter on Instruments), which 
acts efficiently for this purpose, bringing the pressure just 
above the pubis, instead of two or three inches above, as it 
does with the old London supporter. 

Some cases that are obstinate, where the patient is obliged 
to perform much labor while standing, may be benefited by 
the use of the soft gum elastic pessary, taking care to use a 
size that does not distend the w^alls of the vagina too much, 
using it for two or three days and then omitting it for a week 
or more ; but unless the physician is in active gynaecological 
practice, and has the time and patience to properly adjust 



666 EA TON ON DISEASES OF WOMEN. 

and take care of the instrument, it is better to use simply 
the abdominal support ; and this requires some little attention, 
as we may see that compression of the abdomen would do an 
injury, by forcing the uterus lower in the pelvis. 

But I may say, once for all, that unless the physician 
has tact and skill enough to apply treatment in such a way 
as to obtain the desired result (when it is clearly attainable 
with proper skill and care), he had better pass all cases of gynae- 
cology, as well as his other practice, over to some one else ; 
as it is true, not only in these cases but in all others, the 
ignorant, careless use of sounds, speculums, pessaries, sup- 
porters, washes, tents, etc., as well as remedies, can only do 
an injury. 

The remedies to be given in case of neuralgia, toothache, 
constipation, gastralgia, enuresis, palpitation, etc., are the 
same as though the cause was something else. In the albu- 
minuric and uremic condition it is probable Merc. cor. has 
more efficiency than any other remedy; but there are some 
cases that will not be relieved till delivery is accomplished. 
Some cases immediately recover on the event of confinement, 
while others, only recover after weeks of treatment; and 
some, I am sorry to say, never. 

Dr. Goubeyre* states that of sixty-five pregnant women 
attacked with albuminuria, twenty-seven died, thirty-three 
were restored to health, while five remained albuminuric. 
He also states that out of one hundred and fifty-nine affected 
with albuminuria, ninety-four had convulsions. 

This condition is more common in the primipara than in 
those who have borne children, as in the primipara the abdom- 
inal walls are more resisting, and consequently greater press- 
ure is exerted on the renal vessels by the gravid uterus. 
Blatt discovered albumen in thirty out of ninety-nine cases 
of primipara, while in the multipara only eleven cases in one 
hundred and six were observed, as recorded by Bedford. 

* Memoires de 1' Academie Iniperiale de Medicine. Tome xx. 



DISEASES AND DIFFICULTIES OF PREGNANCY. 667 

Convulsions occurring during gestation are usually due to 
the presence of uraemia, as has been stated. The treatment 
should be first directed to the relief of the spasm ; and, 
secondly, to prevent a recurrence of the paroxysm. For 
the relief of the convulsion a few pellets of Bell. 3 X , may 
be put in the mouth, or a few drops of the dilution of Bell. 
3 X , Nux, or Verat. alb. may be given, and the feet wrapped 
in warm wet cloths; or, if convenient, the full warm bath 
may be given or warmth to the spinal column by means of 
warm compresses may be used, and in case of failure to obtain 
prompt relief by these measures Chloroform or Sulph. Ether 
may be given by inhalation, till the convulsion ceases ; after 
which we should ascertain if it be a retro-version that has 
produced the spasm, or if it be from albuminuria. 

If albumen be found in the urine we will generally find 
relief from the use of Merc. cor. 3 X . In some severe and 
extreme cases, where convulsions continue in spite of every 
remedy, we may be obliged to produce a premature delivery 
of the child to save the mother. This procedure better be 
only done after consultation with two or more physicians. 
We generally have time in these cases to obtain counsel, and 
we should always insist upon having it in this class of cases 
before proceeding to bring on premature delivery. Of course, 
the child is viable at seven months, and we may hope to save 
its life in many instances ; but from the fact that we may 
have not only a loss of the child, but the mother as well, we 
had better be fortified with advice from other physicians of 
high standing. We have in these cases not only the danger 
of an ordinary delivery, but the added danger from the use 
of the means to promote the delivery, and also the irritable 
and depressed condition of the nervous system, consequent 
upon the convulsions, as well as general derangement of the 
system from the causes which led to them. Fortunately 
spasms seldom occur previous to the viability of the child ; 



668 EATON ON DISEASES. OF WOMEN. 

still its death may result from the convulsions, if .they con- 
tinue for a considerable time. 

Vomiting may, in some rare instances, be so persistent as 
to endanger the mother's life, and a resort to abortion be 
advisable. (See Vomiting in Pregnancy.) Occasionally the 
slight nausea and occasional rejection of a meal may be a 
conservator of health, acting to prevent undue plethora, as 
after conception and the consequent suppression of menstrua- 
tion, the system has in some instances, a tendency to undue 
plethora ; hence Nux or Ipecac may be the remedies demanded 
to rectify the trouble. If we bear in mind that in pregnancy 
one lady may suffer from anaemia and another from hyper- 
emia, we may understand why the vomiting that is so inju- 
rious to one may conserve health in another. 

We may also observe that the jaundice and sundry other 
disturbances and ailments are caused by the pressure of the 
uterus, and we will be led to rectify the trouble without a 
resort to medicine in some cases. The uterus rises the 
highest in the abdomen at about the completion of eight and 
one-half months of gestation, and owing to some cause the 
uterus may be deflected to the right side, and press so hard 
upon the liver as to interrupt its action, or more generally, 
probably upon' the ductus communis choledochus, and prevent 
the discharge of the bile into the duodenum, hence giving 
rise to jaundice. By directing the patient to lie upon the 
left side and lean towards the left while sitting, seeing to it 
that the clothing is sufficiently loose, we may soon discover 
amelioration of the symptoms, and erelong their complete 
subsidence. 

While speaking of looseness of clothing I will suggest that 
by attention to this matter in cases of renal difficulties, with 
or without dropsical swelling of the limbs, we may do much 
to relieve the trouble. Here we have annoyance to contend 
with, in the desire of women to look small and keep people 



DISEASES AND DIFFICULTIES OF PREGNANCY. 669 

from knowing their condition. This desire is so strong in 
some women that they actually lace themselves to keep their 
size to suit them; hence I am often astonished that they 
have in these cases even the ability to live, and we are 
placed on our guard, in the management of these cases, by 
keeping in mind how the ailments of the pregnant state are 
occasioned. 

In the treatment of the cases of nausea and vomiting 
occurring only at night, I would first ascertain if it were not 
due to retro-version (which I would rectify if it existed), 
and I would positively interdict sexual congress. By com- 
pliance with this direction our patient may expect relief. And 
while on this subject it may not be amiss to intimate that I 
am of opinion that if sexual connection was not in the least 
indulged in during pregnancy, we would have much less of 
suffering during this period. 

The attempt to relieve these inveterate nauseas by giving 
a glass of cold water, warm tea or coffee, or a bite of cracker 
before rising is all well. Acid cit., Acid nit., Puis., Col. 
carb., Ars., etc., have been found often useful in the acidity 
of the stomach that is often so annoying. Failing by these 
remedies it may be best to use a chemical treatment, or food if 
you please, and feed the patient on a little Soda or Magnesia. 

If Xux, Brtj., Sulj)h., etc., do not relieve the constipa- 
tion when given as indicated, enemse of tepid soap water are 
to be used as adjuncts. 

Oanthdr., Bell, Can. ind.^ give much relief to irritations 
in the urethra and bladder, given according to their homoeo- 
pathic indications. 

Diet,— Some attention to diet and exercise are important 
in the treatment of these ailments of the pregnant state. 
The diet should be nutritious, unstimulating, and digestible. 
The exercise should be moderate and in the open air. 
Riding in a carriage is better than confinement indoors; but 
walking exercise is much better if it can be taken. 



670 EATON ON DISEASES OF WOMEN. 

Great gentleness should be shown the pregnant woman. 
We can not be too considerate of her feelings nor too in- 
dulgent in our ministrations for her comfort, for her own 
good and that of her offspring as well. 

Pruritus and leucorrhoea, which are often combined in the 
same case, are troublesome, although only remotely injurious, 
and merit the attention of the physician, on account of the 
nervous exhaustion that the intolerable itching produces 
after a time. The leucorrhoea sometimes is of a bland char- 
acter and gives little trouble, except that it is disagreeable 
to the patient in the soiling of the clothing ; at other times it 
is acrid in character, denuding the mucous membrane of 
the vagina, of its epithelium, causing intense smarting, burn- 
ing pain. Sometimes apthous ulcers are formed on the mu- 
cous surface of the labia, and require applications of Vaseline. 
Frequent use of the vaginal injection of tepid water is of 
benefit in some cases. I have found the insertion into the 
vagina of a wad of cotton high up in the vagina, saturated 
with equal parts of Glycerine and Hydrastis, or Glycerine and 
Tr. Aconite, or Calendula (recollecting to attach a thread or 
string to the cotton to facilitate its removal, and changing 
the application every twelve hours), is a very useful treat- 
ment. Aconite, Sepia, Bry., Puis., and Sulph. are useful rem- 
edies in this class of cases. 

There is a form of pruritus without the leucorrhoeal dis- 
charge, where the sensation is that of burning, sometimes 
giving the sensation of the crawling of pediculi. This 
variety is mostly confined to the cutaneous surface of the 
labia and the mucous membrane covering the clitoris. Both 
varieties of pruritus may result from disease of the uterus, 
as well as pregnancy ; but I think we have them more fre- 
quently in pregnancy than otherwise. This variety last 
mentioned is evidently abnormal nerve sensation or sensi- 
bility, which is peculiar to some women, or to women at par- 
ticular times. Camph., Apis, or Ars., are probably the best 



DISEASES AND DIFFICULTIES OF PREGNANCY. 671 

remedies in these cases. If abnormal sensitiveness of the os 
uteri be observed, one or two applications of Bell, ointment 
may be made to it, and the labia may be bathed three or 
four times a day with a wash of one part of Glycerine to 
three of water. Attention must also be given to the general 
health and diet of the patient. 

In all these ailments we do well to see to it that our 
patient does not get excessively fatigued, but takes frequent 
rest in the horizontal position during the day. 

In cases of inflammation of the breast, where there is a 
secretion of milk, it must be artificially drawn two or three 
times a day in some cases ; in others, once a day is sufficient. 
Bell, is the chief internal remedy indicated, and it may also 
be applied locally to the inflamed part. 



672 EATON ON DISEASES OE WOMEN. 



CHAPTER LIX. 

VOMITING IN PREGNANCY. 

Vomiting in pregnancy is sometimes exceedingly annoying 
to the patient, her friends, and her physician. Ordinarily it 
occurs only upon rising in the morning, or after breakfast; 
but in some instances the nausea comes on worse in the after 
part of the day, and sometimes is continuous, apparently 
causing the rejection of all the food and drink taken into 
the stomach. In these extreme csis.es the gravity of the 
symptoms becomes alarming, and the life of both mother and 
child is endangered. 

Authors upon diseases of women have either ignored this 
subject, or treated it as of little moment. Works upon ob- 
stetrics are almost as silent, and college professors also 
have usually slighted the subject. Hence, the young practi- 
tioners are left without sufficient guidance in this complaint, 
most of them having from their readings been impressed 
with the idea that vomiting was rather physiological than 
pathological. 

These young men find upon engaging in active practice 
that cases of vomiting in pregnancy come to them for relief. 
The question arises, In what can relief be found? They 
then naturally ask themselves, Why this manifestation? 
What are the conditions producing it? Why do some escape 
and others suffer? They naturally consult books, and find 
either no mention made of the complaint or only an unsatis- 
factory allusion. 

These considerations have prompted me to include this 
subject in this work, although it more properly belongs to 
the department of obstetrics. 



VOMITING IN PREGNANCY. 673 



Etiology. 

Just here we venture upon contested ground. Although 
the contest has not been sharp or decisive, it has torn up the 
soil enough to perhaps enable us to get at some light upon 
the subject. As gestation is established the uterus enlarges, 
and, of course, becomes heavier than in its un impregnated 
state. (And it is well known that it settles down in the 
pelvis during the first three months of pregnancy below its 
normal position.) This may account for the nausea produced 
by rising from the recumbent position while the stomach is 
empty through the sympathetic nervous irritation caused by 
the downward displacement just mentioned. In some cases 
this nervous irritation is caused by the enlargement of the 
womb alone; in some cases, due to a sub-acute inflammation 
of the organ ; sometimes to irritation of the uterus from cop- 
ulation after pregnancy has occurred. The general nervous 
irritability of the patient may predispose to this condition. 
It is, hoAvever, none the less a pathological or diseased con- 
dition which manifests this symptom. 

We think it time that the profession was outspoken on 
this point. It may cast reflections upon the method adopted 
by fashionable society, and even by civilized nations, in the 
rearing of children, and apply with special force upon those 
of the present generation; but let it fall where it may, it is 
time the people understood that they can not ignore the laws 
of their physical being, and still have health and an easy 
procreation, devoid of annoyance and danger, like the an- 
imal creation. We must remember that we have an ani- 
mal frame, requiring, not only healthy food, but pure air and 
plenty of physical exercise. Our daughters are reared to-day 
with a scant supply of all these, and have inherited none too 
good a constitution from their parents. Let us, then, place 
the blame where it belongs, and not by intimation censure 
our Creator for making women so as to suffer these things. 

43 



674 EATON ON DISEASES OF WOMEN. 

Diagnosis. 

In diagnosis the absence of menstruation in the married 
woman, previously regular, together with other symptoms, 
will indicate that the nausea is due to pregnancy, or rather 
the condition produced by pregnancy. The history of the 
case should show an absence of gastric disturbance previous 
to the arrest of menstruation. In these cases the smell of 
food is often as nauseating as its taste. A somewhat similar 
train of symptoms may arise from uterine disease or displace- 
ment, independently of pregnancy; hence, we must be some- 
what careful in noting the history of the case, as well as all 
the symptoms present indicating pregnancy, in order to make 
a correct diagnosis. Most cases are clear, but 'tis well to be 
on our guard against error in the exceptional ones which 
sometimes come before us. 

Treatment. 

The suggestions which I have made regarding the etiology 
suggest the treatment. In some cases we should proceed as 
though the patient was suffering from displacement of the 
uterus. Rest in the recumbent posture is one means of 
allaying the irritation. Sometimes the abdominal supporter, 
by taking off the weight of the intestines from the uterus, 
and relaxing the strain upon the broad ligaments, relieves the 
symptoms. Conjoined with these measures the use of the 
inflatable pessary in the vagina by lifting up the uterus re- 
lieves the trouble. Bathing the abdomen and spine with 
Chloroform wash is often of service. The tepid sitz bath, 
used daily for fifteen minutes, is of some service in those 
cases where there is much tenderness of the uterus. 

Internal Remedies. 

Oxalate of Cerium, Puis,, Ars., Ipecac, Cal. carl., Aeon., 
Nux, Sepia, etc., sometimes give some relief, if indicated by 



VOMITING IX PREGXAXCY. 675 

the symptoms other than the vomiting, as well as this one in 
particular. Bell., Ht/os., Ignat., Gelsem., Secale cor., or Arnica are 
sometimes of benefit when there are nervous symptoms which 
strongly indicate their use homceopathically. We should be 
sure in obstinate cases that there is not retro- version or retro- 
flexion of the uterus causing the nausea. This can be best 
detected , if the case be one of retro-flexion in the gravid 
uterus, by means of rectal examination. The uterine sound 
must not be introduced for the purpose of diagnosis or treat- 
ment in the suspected case of pregnancy, as being too likely 
to produce an abortion. Taking a little food or a drink of tea 
or coffee before rising has been found, by some, a relief to 
the nausea, though not curative. 

The remedies and treatment I have suggested will, in the 
majority of cases, give relief, and in many a complete cure is 
effected with them. There are however, I regret to say, 
some few cases where all these means fail, and the serious 
question arises, What is to be done? Sometimes the vomit- 
ing is so constant that the patient is in imminent danger of 
dissolution from actual starvation. In these extreme cases 
rectal injections of beef tea may be tried. The patient con- 
tinuing to go down in spite of these injections the question 
arises, Shall we resort to abortion to save the patient's life ? 
Obviously, before this is done, a consultation should be held 
(as in case of convulsions) with at least two medical gentle- 
men of good standing, and their concurrence in the necessity 
of the procedure should be obtained before making any 
attempts to evacuate the uterus. 

Dr. W. W. Potter,* of New York, reports a case, with 
comments upon the arguments pro and con regarding the 
operation, which I will quote. He says : 

"There is, perhaps, no malady which puts to a severer 
test the resources of the obstetric practitioner than extreme 
cases of nausea and vomiting dependent, etiologically speak- 
* Amer. Jour, of Obstet., January, 1880, page 85. 



676 EATON ON DISEASES OF WOMEN. 

ing, upon the gravid uterus. It is, therefore, fortunate that 
we only now and then meet with a case of that sort, demand- 
ing the extremest expedient for its relief known to the 
obstetric art; namely, the artificial induction of abortion. 
Since but very few of these extreme cases can fall within the 
observation of any one physician, I shall assume that a de- 
tailed history of one which lately came under my ministra- 
tions will not be devoid of interest. 

" March 26, 1879, was called seventeen miles to see Mrs. 
J. L. T., aged twenty-three years, and who had been married 
a little more than five months. I found her about ten weeks 
advanced in pregnancy, and also suffering from chronic bron- 
chial catarrh. She was greatly emaciated; vomited all food, 
and even water was at once rejected, the nausea being per- 
sistent and constant. Pulse 80, and feeble ; temperature 
99° F. She also complained of neuralgic pains in the right 
chest wall. Examination, per vaginam, revealed a gravid 
uterus, and the speculum further disclosed chronic endo- 
cervicitis with granular erosion of the os and lower segment 
of the uterus, accompanied by the characteristic discharge 
incident to the pathological condition described. 

"Clearing away the thick, tenacious mucus clinging to the 
parts, I applied Tr. of Iodine to the os and cervical canal, 
after which a pledget of cotton wool, which held about one 
drachm of the following mixture, namely : 

Chloral hydratis 3 ij. 

Acidi carbolici gr. x. 

Fl. ext. opii 

Glycerinse aa 3 ij. M. 

was packed snugly around the os, and held in place by other 
dry cotton pledgets. 

"I advised that the stomach be entirely abandoned for 
the purposes of nutrition, and that rectal alimentation be sub- 
stituted ; and further suggested the use of a Kreosote mix- 
ture per orem, to be used cautiously, and to be discontinued 



VOMITING IN PREGNANCY. 677 

if it should not be well retained. It is proper to add that 
this was intended to be a consultation visit, but the physician 
who had already attended Mrs. T. for four or five weeks did 
not arrive until just as I was taking my leave, when I sub- 
mitted my plans to him, and secured his cordial assent. 

"April 2d. — Saw Mrs. T. again to-day, one week after my 
first visit; found her suffering considerably from neuralgic 
pains in the right thoracic wall; stomach less irritable, though 
all food given per orem is still rejected, this having occa- 
sionally been tried, notwithstanding my injunctions to the 
contrary. I renewed the applications to the os and cervix 
uteri in the same manner as on the former occasion ; gave 
one-sixth grain of Morphia hypodermically for the relief of 
the thoracic pain; advised lime water and milk in small doses, 
and continued the Kreosote mixture, as the patient fancied it 
had been of some benefit. 

"The emaciation had increased since my last visit, and 
anemia was now extreme. The nutritive enemata, consisting 
of beef essence, milk, brandy, and laudanum, had been toler- 
ably well retained, and I therefore advised their continuance 
as a chief dependence for nutrition. 

"April loth. — Was summoned by telegraph late at even- 
ing (Sunday), to visit Mrs. T. ; arrived at ten o'clock P. M., 
and found Dr. Barross, of Attica, in consultation with Dr. 
Young, the attending physician. Her stomach was now 
rejecting every thing; nausea and retching constant; emacia- 
tion and anemia progressing. She was sleepless ; tempera- 
ture 100° F. ; pulse 110 and feeble, with the vitality greatly 
depressed. Her mother stated that the patient had had 
three convulsions during the day, which so alarmed the 
friends that they had associated Dr. Barross (who resided 
eleven miles nearer the patient than myself) with Dr. Young, 
pending my arrival. 

"I presented to these gentlemen the propriety of the 
artificial induction of abortion in the case ; but they were 



678 EA TON ON DISEASES OF WOMEN. 

both minded otherwise, fearing fatality as a result, and which 
now seemed inevitable to them under any plan. I, there- 
fore, advised Chloral hydrate and the Potassium bromide (thirty 
grains of each) in emulsion with yolk of egg and milk per 
rectum, to be administered at once. This was done about 
eleven o'clock P. M., and it brought about a comfortable 
night's sleep. 

"April 14:th. — Next morning our patient seemed in a more 
encouraging condition ; her pulse was slightly stronger, and 
there had been neither nausea nor retching since midnight. 
Advised continuance of the Chloral and the Potassium salt 
per rectum, from two to four times a day ; also beef essence, 
milk, and brandy in the same manner. Per orem, small 
quantities of iced lime water and milk, if retained. 

"April 18th. — Was again summoned by telegraph; found 
patient suffering from repeated nausea and vomiting; greatly 
prostrated; pulse 116; temperature 100.05° F. ; emaciation 
increasing, and bronchial symptoms more aggravated. 

u The rectum had now become so irritated that medica- 
tion and alimentation by that method had to be suspended; 
therefore, I now determined that the induction of abortion 
should be no longer delayed, particularly as it seemed to 
offer the only chance of saving life, even though, apparently, 
never so slight a one. Accordingly, with the concurrence of 
the attending physician, I dilated the os with the finger, the 
patient being in the Sims' position, and passed into the 
uterus a piece of carbolizecl catgut about twelve inches long, 
doubled upon itself, retaining it by pledgets of raw cotton, 
neatly and snugly packed around the os. I administered 
morphia hypodermically, and left the patient under the close 
surveillance of Dr. Young. 

"April 24:th. — Visited the patient again by appointment, 
when I learned that at five o'clock P.M., on the 22d, a three 
and one-half months foetus (it was saved for my inspection) 
had been thrown off, and that the placenta followed soon 



V0M1TIXG IN PREGXAXCY. 679 

after, all without hemorrhage or anything worthy the name. 
All her symptoms now seemed better ; she was cheerful, and 
took nourishment per orem, cautiously administered, brandy 
and cream, etc.; temperature 99.05° F. ; pulse 88, and no 
nausea nor vomiting. Gave her iced champagne, which she 
enjoyed. 

April 21th. — Saw Mrs. T. again by appointment; there 
had been no return of nausea ; bronchial symptoms much 
improved ; strength slowly increasing, and food is taken with 
relish. Continued nourishment per orem. with champagne 
and Mensinan's beef tonic. 

"Sept. §th. — Mrs. T. visited me. She was at this time 
quite strong and well, and about to undertake housekeeping. 

"At the risk of being wearisome. I have been somewhat 
diffuse in the relation of this case, while at the same time I 
have abridged many of its details. It is proper, however, 
that I make further mention of one or two special features of 
the case. 

"I. Let it be noticed that there was inter-current catar- 
rhal bronchitis, complicating the excessive nausea and vomit- 
ing of pregnancy, which in no small degree embarrassed its 
therapeutical management, since the remedies necessary to 
control the bronchial symptoms could not be retained by the 
stomach. The bronchial catarrh had, up to the time of my 
first visit, been the sole source of anxiety on the part of the 
friends of the patient, and thus far had entirely absorbed the 
offices of her physician. Neither had yet suspected preg- 
nancy, believing that the suspension of the menstrual func- 
tion was due to the general debility and anemia growing 
out of the bronchial disease. Now that the uterus was pro- 
nounced gravid, an additional and greater source of danger 
was discovered, and anxiety on all hands became extreme. 

"II. The second point of special interest to which I 
would refer, before dismissing the case altogether, is the ex- 
tensive superficial ulceration of the lower segment of the 



680 EA TON ON DISEASES OF WOMEN. 

uterus, attended, ns it was, by the profuse egg-like discharge 
which is so often found present in similar conditions. I fan- 
cied that I had discovered in this the true source of fill the 
difficulty, and that I had but to remove it, when the nausea 
and vomiting would depart. In her very feeble state, how- 
ever, I found it exceedingly difficult to make the necessary 
local applications ; and becoming convinced, also, that the 
ulceration was no longer tractable to the use of mere topical 
remedies, I determined to abandon them altogether; more- 
over, rectal alimentation ;md medication having failed to 
arrest the progress of the malady, the direful alternative of 
putting an end to the pregnancy was forced upon me. 

"I: will now offer some remarks germane to the whole 
subject of excessive vomiting and inanition of pregnancy, 
the case reported having furnished an appropriate text 
therefor. 

" First, let us briefly examine the subject with reference 
to the etiology of this vomiting; and, be it understood that 
we are speaking generally, dealing only with cases where 
this symptom of the gravid state is so severe and persistent 
as to threaten the life of the patient, since, in the main, the 
ordinary vomiting in pregnancy may be regarded as a useful 
and not an abnormal symptom. 

"A few obstetricians strongly advocate the theory that 
some displacement of the gravid uterus is, in almost every 
instance a cause of vomiting, and notably among their num- 
ber we find the name of Dr. GraiHy Hewitt; others refer 
the condition to granular inflammation of the os, cervix uteri, 
cervical canal, or os internum; others, again, believe that the 
symptom is clue to the stretching of the uterine fibres; 
while still others regard it as a reflex phenomenon due to 
the gravid state, a condition which has been so happily 
termed by Dr. Geo. J. Engelmnnn, of St. Louis, as a hystero- 
neurosis of pregnancy. Let me quote his own words. 'I 
will/ remarks Dr. E., ' merely recall the various gastric symp- 



VOMITING IN PREGNANCY. 681 

toms which occasionally accompany pregnancy ; . . . the 
uterus after conception, as previous to the menstrual flow, is in 
a more active sensitive condition; it is congested and en- 
larged, and the nausea, the vomiting, and epigastric distension 
occasionally found during pregnancy, may also be classed 
among the hystero-neuroses, as we know that in some cases 
these symptoms may be relieved by dilatation of the cervical 
canal, and always by the discharge of the ovum, whether at 
term or sooner, thus proving their dependence upon the 
uterine condition.'* 

"Prof. Samuel C. Busey, M.D., of Washington, D.C., in 
a, paper lately published,^ 'On the Potassium Bromide and 
Suspension of the Action of the Stomach in the. Uncontroll- 
able Vomiting of Pregnancy,' has interpolated some remarks 
upon the etiology of the disease, which are so germane to 
the proposition which I have just advanced, and, withal, so 
concisely stated, that I shall take the liberty of quoting them 
here. ' The nausea and vomiting of pregnancy,' says Dr. 
Busey, 'are undoubtedly, in a vast majority of cases, reflex 
phenomena, but it is not improbable that occasional excep- 
tions occur, and in a large proportion of, if not in all, the 
cases when these stomachic disturbances become serious, and 
for a time uncontrollable, catarrhal conditions of the gastric 
mucous membrane are superadded. The clinical history of 
cases of acute gastric catarrh, and of cases of protracted and 
uncontrollable vomiting of pregnancy, are very analogous. ' 
Anorexia or a vitiated appetite, nausea, vomiting, thirst, 
epigastric oppression or pain, a saburral condition of the 
tongue, eructations of a glairy mucus, and despondency, are 
common to both affections. In fact, there is not a symptom, 
except such as may relate to the reproductive organs, belong- 
ing to either which may not be present in the other. The 
most frequent cause of catarrh of the stomach is indigestion, 

* Trans. Am. Gynaecological Society, Vol. II, p. 518. 
t Am. Jour. Med. Sciences, January, 1870, p. 112. 



682 EA TON ON DISEASES OF WOMEN. 

due either to an indiscreet diet or to derangement of the 
digestive process. Impoverishment of the blood disqualifies 
the gastric fluids, and the inanition of pregnancy, so fre- 
quently the precursor of the more serious stomachic dis- 
turbances, may thus become a potential factor in their 
causation.' 

" I have by no means exhausted the list of causes which 
have been enumerated by different writers upon this subject, 
but enough have been mentioned to illustrate the fact that, 
as they are various and variable, so, too, will the treatment 
recommended vary in method and application. 

"As we are dealing only with extreme cases, where life 
is placed in great jeopardy from the prolonged and constant 
nausea and inanition of pregnancy, so, in the consideration of 
treatment, shall we, likewise, confine our remarks to the 
extreme measures requisite for its relief. 

" These will be discussed under three general heads, viz. : 

"I. Stomachal rest. 

" II. Rectal alimentation and medication. 

"III. The artificial induction of abortion. 

"I. The first indication of treatment, then, in these ex- 
treme cases, speaking generally, is absolute and complete rest 
for the stomach; not only must all food be positively inhib- 
ited, but so also must all drinks, in large or small quantities, 
be excluded per orem. So necessary to success is stomachal 
rest, I am convinced, after considerable observation, that 
there must be a positive prohibition of all alimentation by 
the stomach; and that under no circumstances must we allow 
the cravings of the patient or the entreaties of her friends 
to persuade us to relax this stern and apparently cruel man- 
date. To relieve thirst, dryness of the mouth, and the 
parched condition of the lips small chips of ice may be 
allowed per orem, but nothing else. 

"' Cases occur,' remarks Dr. Busey,* 'in which the stom- 

"*Op. cit., pp. 114, 115." 



VOMITIXG IN PREGNANCY. 683 

ach will not tolerate any thing, either liquid or solid. Oc- 
casionally, when some simple article of food is for a time 
retained, it simply accumulates, and is finally expelled undi- 
gested. Digestion seems to be suspended, or so disturbed 
that stomachal alimentation is impossible.' 

"This is undoubtedly the experience of every one who 
has had much to do with this malady. Why, then, should 
we torture the already disturbed, irritated, and rebellious 
stomach by the introduction of even the blandest aliments? 
Better far to wait until rest and time have sufficiently 
repaired these disturbances to warrant the gradual resump- 
tion of stomachal alimentation, and to inspire the belief that 
the assimilative process may also be restored. 

" By the same inexorable rule that we prohibit the inges- 
tion of food would we also deny the introduction of medicines 
per orem, for the self-same reasons Avhich govern in the one 
case apply with equally cogent force in the other. 

"II. Of rectal alimentation and medication. 

"The same dire necessity which compels us to abandon 
the stomach for purposes of nutrition and medication forces 
us to adopt the rectum for like uses; and fortunate it is that 
nature has so wisely provided such a valuable and efficient 
substitute, enabling us thereby to sustain life for even a 
lengthened period, should such a necessity arise. 

"It is a well known fact that in many stomachic, eso- 
phageal, and pharyngeal disorders rectal alimentation has 
been employed with more or less success, oftentimes, indeed, 
it being the only method of sustaining nutrition for weeks, 
months, and even years. I shall not attempt to enter into a 
historical review, nor to discuss in extenso the rationale of the 
rectal method of alimentation, but shall simply submit a few 
remarks in regard to its applicability and usefulness in the 
nausea and inanition of pregnancy. 

"The most valuable recent contribution to the literature 
of this subject is a paper by Dr. Henry F. Campbell, of 



684 EA TON ON DISEASES OF WOMEN. 

Augusta, Ga., submitted to the American Gynaecological 
Society at its annual meeting in 1878,* from which many 
of the thoughts here suggested have been formulated. 

"If it is important — nay, absolutely necessary — that the 
stomach shall have rest in 'gravid nausea/ it is equally im- 
portant that nutritive elements shall be furnished in some 
artificial manner in sufficient quantities to maintain the vital 
standard to such a degree that there shall at least be no loss 
by the prohibition of stomachal alimentation. It has been 
demonstrated over and over again that this was possible ; but 
just how the rectal food was prepared for, and finally intro- 
duced into, the blood has been a matter of controversy, 
conjecture, and doubt, until Dr. Campbell 'cut the Gordian 
knot' by his ingenious and, to my mind, conclusive explana- 
tion of the modus operandi by the method which he has so 
simply and aptly termed 'intestinal inhaustion.' f 

"If the rectum or colon were alone depended upon to 
absorb or convey to the blood the nutritive enemata very 
little or no good could come from their use, since both of 
those organs are devoid of the digestive juices so necessary 
to the preparation of all aliments for their absorption into 
and admixture with the blood. It is highly probable, how- 
ever, that when food is properly placed in the rectum there 
is a reversion of the ordinary and normal peristaltic action of 
the intestinal tube, which carries it upward until the small 
intestine is reached, where those digestive juices are found 
which prepare the food for chylous absorption in the same 
manner as though the aliments came by way of the stomach 
instead of the rectum. Nay, more ; is it not likely that food 
which finally reaches the blood up through a healthy avenue 
is better fitted for the nutrition of the body than when sent 
downwards through a stomach irritated and disturbed, with 
its secretions chemically at fault, and its functions rendered 
morbid by the hystero-neuroses of pregnancy? 

"* Gynaecological Trans., Vol. Ill, p. 268." "tOp. cit., p. 282." 



VOMITING IN PREGNANCY. 685 

" Let us interrogate Dr. Campbell in this connection with 
reference to the manner in which rectal alimentation is made 
to serve the purposes of nutrition in these cases. 'I have 
already,' says Dr. Campbell, 6 defined the method by which 
I account for the digestion, absorption, and assimilation of 
food when placed in the rectum. It is this, differing from 
all others with which I am acquainted, that digestion in 
either rectum or colon is not at all contemplated — neither 
by direct absorption on the part of the Avails or vessels of 
these cavities; nor by the means of artificial digestive prin- 
ciples added to the food after the manner of Leube; nor by 
the glands of the large intestine vicariously secreting the 
digestive fluids of the small intestine; nor, lastly, by the 
alimentary mass in the large intestine exciting the secretions 
of the stomach and small intestine, and then attracting, or in 
some way acquiring, them, in order that rectal digestion may 
take place. 

"'My proposition is distinctly the reverse of this last, 
and asserts that instead of the digestive principles descend- 
ing to the food to digest it the food ascends to these fluids 
in the small intestine, and that it is there digested and pre- 
pared for absorption by the proper organs in precisely the 
same manner as after buccal ingestion.'* 

"I am at this moment feeding four patients per rectum 
for various maladies (one being for gravid nausea and inani- 
tion) ; and I should be glad to introduce notes of these cases 
in this paper, but I forbear lest I wax wearisome with many 
details. It is sufficient to say that they all tolerate the 
method well, and are improving under it. I have interro- 
gated each patient carefully, after having instructed them to 
make particular observation as to recto-staltic action, and 
they all assert that they can 'feel the food going upwards 
into the intestines' a little time after its introduction. 

"Dr. Nathan Bozeman, of New York, in a recent, most 

"*Op. cit., p. 285." 



686 EATON ON DISEASES OF WOMEN. 

valuable contribution to the literature of ovariotomy,* has 
demonstrated the superiority of both rectal medication and 
alimentation, even before as well as after the operation. 

"Dr. M'Clintock read a paper on the subject before the 
Obstetrical Society of Dublin, March 12th, 1873,f in which 
he gave the report of a case which was reduced to the very 
last degree of prostration and weakness when the abortion 
was provoked, insomuch that the preservation of her life 
seemed scarcely possible; nevertheless, she made a good 
recovery and again became pregnant. 

" Dr. M'C. also gives in his paper a table of thirty-six 
cases where abortion had been artificially produced to rescue 
the patients from the fatal effects of their persistent and 
excessive vomiting. In twenty-seven of these cases the 
nausea and vomiting was completely arrested and the patients 
perfectly recovered; in the remaining nine cases, while the 
vomiting was stopped, ultimate recovery did not take place. 
The result in these nine instances the author thinks due, in 
part, to the fact that the operation had been too long de- 
layed; and in part to the fact that concurrent disease in 
some form had complicated the cases so as to put recoA r ery 
out of the question under any plan. 

"Dr. M'Clintock also cited fifty cases, from various 
authentic sources, where death had actually taken place in 
consequence of the persistence and uncontrollable severity 
of the pregnant sickness. 

"It now and then happens in those cases, that nature 
herself comes to her own relief and turns out the offending 
uterine contents, thus clearly indicating the correctness of 
this line of practice in exceptional instances. This occurred, 
indeed, in the very case which Dr. Campbell makes the 
basis of the valuable paper to which I have frequently made 
reference in this rambling communication. 

"-See New York Med. Kecord, July and August, 1879." 
"t Irish Hospital Gazette, May 1, 1873." 



VOMITING IN PREGNANCY. 687 

"I will conclude by formulating some of the principles 
which we seek to enforce : 

" I. That in extreme cases of gravid nausea the stomach 
often becomes so disturbed in its functions as to render the 
digestion of food harmful, nay, even impossible. Hence 
arises a degree of exhaustion and inanition which may result 
in death. 

"II. That stomachal rest, which oftentimes must be 
absolute as far as a positive prohibition of all buccal inges- 
tion can make it so, must be strictly enjoined; moreover, 
this may be, and often is, a condition precedent to thera- 
peutical 'success in the management of cases where life is 
threatened. 

"III. That rectal feeding and medication become alike 
important factors in securing the necessary rest for the 
stomach, and indispensable ones in maintaining and improv- 
ing the nutrition of the body. 

".IV. That the maintenance of nutrition by means of 
rectal feeding is accomplished by a ' reversal of normal pe- 
ristaltic action' in the intestinal tube — the £ retrostalsis ' or 
4 intestinal inhaustion' of Campbell; and, further, that to Dr. 
Campbell belongs the credit of first bringing to the notice of 
the profession this newly-discovered function of the aliment- 
ary canal, whereby the true rationale of rectal alimentation 
seems fully explained. 

"V. That by 'the careful and systematic' employment of 
feeding and medication through the rectum, the necessity for 
the artificial induction of abortion for the relief of gravid 
nausea may be reduced to a minimum. 

"VI. And, finally, that in cases which have resisted the 
employment of all milder expedients, and life still seems 
threatened, the induction of abortion for the relief of the 
excessive, obstinate, and uncontrollable vomiting of preg- 
nancy becomes an alternative measure, justifiable alike by 
medicine and morals." 



688 EA TON ON DISEASES OF WOMEN. 



CHAPTER LX. 

PUERPERAL MANIA. 

Mental derangements are but imperfectly understood. 
We note some of the phenomena of the mind, but of the 
workings of the brain, nerve currents, thoughts, emotions, 
etc., we are about as ignorant as was Aristotle or Hippo- 
crates. To draw a line clearly defined between sanity and 
insanity is to-day an impossibility. There is such a variety 
in the mental peculiarities of those considered sane, so many 
idiosyncrasies among those whose entire sanity is sometimes 
doubted (and as often defended), that we can in no manner 
clearly define the boundary line between sanity and insanity. 
Still we may be able to clearly distinguish the difference 
in the two realms of mentality when fully within their 
borders, figuratively speaking. 

If any one thinks he understands mental derangements, 
let him try to explain the conditions and symptoms which 
indicate them, and he will soon find how careful he must be 
in his language not to include in the description of mania 
some symptoms often manifested by those considered sane. 
Many books have been written and much said upon the sub- 
ject, but all have left the matter with their thoughts so 
shrouded in the profusion of verbiage that they are not easily 
discerned. This is a charitable view to take of the matter. 
Here is a wide field for discovery, and I hope that some one 
will soon be able to give us clearer views of the operations 
of the mind, both in health and disease. 

So far as I can learn there is now no standard by which 
we can positively judge of mild aberrations of mind. We 
can not say one is insane on account of peculiarities of judg- 



PUERPERAL MANIA. 689 

ment, unless these peculiarities have come on suddenly to one 
previously free from them. For some people are very pecul- 
iar all through life, and should Ave judge them, in comparison 
with the mass of mankind, we would say they were of un- 
sound mind. They do things which mankind do not approve 
of, seemingly with the sanction of their own judgment and 
conscience, and have a distinct recollection of what they have 
done. This is strikingly exemplified in cases of religious 
bigotry and zeal, even carried to the extent of murdering 
their own children and their fellow-men in the service, and 
to please a God of love, mercy, and tenderness. To the world 
at large, these acts look like evidences of insanity ; still, the 
whole sect to which they belong may approve and applaud. 

If a certain act is performed, and the person performing- 
it has no recollection of it, the act is like that of the som- 
nambulist, and he is not responsible. But the trouble arises 
in this case to make it clear that the act was committed while 
unconscious. Again, simple forget fulness will not indicate 
insanity (would that it did, especially to affect those who 
forget to do as they agree). 

But it is of puerperal mania I would speak. We find 
that there are certain reflex influences from the uterus affect- 
ing the brain in some cases. This is first manifested at 
puberty, the girl's whole mentality seeming to change after 
the catamenia is established. Again, in disease and displace- 
ment of the uterus, pain in the head is of almost constant 
occurrence. It is, therefore, found to be, as might be ex- 
pected, that the processes of gestation and delivery affect 
the brain, and, in some instances, produce aberration of the 
mind. 

Hence we find the puerperal woman manifesting symptoms 
entirely at variance with the ordinary character of the pa- 
tient. Sometimes in one way, sometimes in another. In 
some cases consisting of ravings, disjointed mutterings, etc* ; 
in others, obscenity and vulgarity; while others are indifferent 

44 



690 EATON ON DISEASES OF WOMEN. 

to their offspring, and even have aversion to them, to the 
extent of taking their lives, in some instances. These mani- 
festations coming on in connection with gestation, following 
after, or occurring at, the period of confinement, are termed 
puerperal mania. 

There is nothing very peculiar in the disease from other 
cases of insanity in women, except in regard to its causation, 
it being dependent upon a want of equilibrium in the ner- 
vous system, over-excited and depressed by the irritation of 
the uterus, affecting especially the nerves, and occurring 
either during or shortly following gestation. 

Diagnosis. 

The disease is easily diagnosed. The derangement of 
mind is not to be confounded with the delirium of puerperal 
peritonitis. The cases to which the term puerperal mania is 
properly applied are those where there is no special disease 
of the system manifested which has brain symptoms in con- 
nection with it, although the continuation of hallucinations 
of the brain after the disease which had appeared to cause 
them had subsided, for some time, would correctly receive 
the term puerperal mania, if occurring immediately subse- 
quent to delivery. 

Treatment. 

Hyoscyamus, Gelsem., Bell., Ignatia, Glonoine, Phytolac. dec., 
Verat., Puis., China, Ars. alb., etc., may be indicated. Each 
case must be studied, and the homoeopathic remedy selected. 
Much depends upon the temperament, constitution, and sta- 
tion in life of the patient, her domestic happiness or unhap- 
piness, her inherited diathesis, etc., etc. 

One of the first things to be clone is to make such 
arrangements for her care as to prevent her doing injury to 
any one. The physician should be very careful on this 
point, as we know how liable these paiients are to commit 
extreme acts; and her friends are not likely to appreciate 



PUERPERAL MANIA. 691 

the danger; they, having known her as full of gentleness, 
tenderness, and love, can not think she would do any vio- 
lence. The patient should be in a temperature which is 
moderately cool, but she must be well protected with cloth- 
ing. Her general health may be such as to admit of her 
taking exercise ; if so, she may ride or walk in pleasant 
weather. Close confinement is not desirable, except w T hen 
absolutely necessary, owing to her general health, her vio- 
lence, or liability to make immodest exposure of herself. 

The nourishment should be governed by the condition of 
the patient. If hyperaemic, let her live on light diet — veg- 
etables, fruits, etc. If anaemic, give meats, soups, and as 
generous a diet as she can digest. Frequent bathing, with 
fictions to the entire cutaneous surface, is of great utility. 

Indications for Remedies. 

Ars. Alb., great weakness, with nausea; alternations of 
heat and cold; aching of the limbs; diarrhoea accompanying 
the cerebral symptoms. 

Bell, has the flushed face ; rush of blood to the head, etc. 

China, after excessive hemorrhages; atonic and anaemic 
condition. 

Gelsem., for violent raving; sees demons; fright; de- 
spondency. 

Grloiioine, stupidity; muttering delirium; congestion. 

Hyos. is indicated in a disposition to weep, and with 
a tendency to be immodest. 

Igiiatia, in nervous tremors ; restlessness ; exhaustion. 

Phytolac, in scrofulous patients ; lymphatic temper- 
ament. 

Puis., when the disease is accompanied with loss of ap- 
petite, and pain in the back of the head. 

Verat. Alb., violent disposition; cold sweat upon the 
forehead ; passive congestion of the brain. 



692 EATON ON DISEASES OF WOMEN. 



CHAPTER LXI. 

diseased and deformed nipples— milk fever— abscess 
of the breast— tumors of the breast, cancer, and 
amputa t10n of the breast. 

Excoriated Nipples — Fissures of the Nipples. 

These affections, though not dangerous, are extremely 
painful to the patient, and merit the earnest attention of the 
physician, as one important duty of his is to relieve the suf- 
ferings of his patients. 

These affections occur, of course, during lactation. The 
child is sometimes allowed to nurse almost continuously on 
account of fretfulness and colic (which, by the way, is an 
efficient means of making the colic and fretfulness worse). 
The nipple becomes denuded of its epithelium, or becomes 
cracked, and then every effort of the child to nurse becomes 
very painful. The mother is placed in an agony of pain 
each time she gives the child the breast. 

If only one nipple is affected she is inclined to let the 
child nurse the other entirely, and leave the affected nipple 
alone, which tends to produce an over-fullness of milk, and 
develop mammitis or mammary abscess. There is perhaps 
no affection of women which causes more dread and agony 
than excoriated and fissured nipples. 

Treatment. 

Arnica, internally and externally, is an excellent remedy. 
Basilicon ointment, pressed down into the fissure, after wiping 
the parts dry from all the secretions of the child's mouth 
after nursing, is the most efficient remedy I know. Calendula, 
Borax, Alum, and Collodion are used by some. I have used 
them all, but none equal Basilicon ointment in my experience. 



RETRACTED NIPPLES. 693 

It is of great importance to have the child nursed as 
seldom as possible in these cases, (i.e.) not often er than 
three hours, using one breast one time and the next time 
the other. This gives six hours for the healing process to 
go on. We will often obtain better results by using Kent's 
nipple shield when the child nurses, which will help to pre- 
vent tearing open the laceration, and allows of the formation 
of new epithelium. 

The Basilicon ointment is as harmless to the child as any- 
thing which can be used upon the nipples ; and, besides, is 
the most efficient. It is composed of Olive Oil four parts, 
Pitch, Wax and Resin, each one part. It is stimulating, and 
it is in accord with homoeopathy to apply an irritant to cure 
an irritation, though it be applied externally instead of in- 
ternally. 

Retracted Nipples. 

This affection, which is sometimes due to abnormal de- 
velopment, or to the contraction of a cicatrix following an 
abscess of the breast which has opened, or has been lanced 
near the nipple, is also clue to the pernicious fashion of the 
ladies of this day in using pads to simulate breasts, or to 
make the appearance of a large development of the mammae ; 
and in the case of large development of the breast, the use 
of corsets to compress them, the ladies seemingly unwilling, 
in either instance, to allow nature to have her way at all. 
The result has been retracted nipples in many, and generally 
an imperfect development of the breast in the majority of 
American women. Retracted nipple tends to the develop- 
ment of mammary abscess, by preventing the free evacuation 
of the milk tubes, and is productive of much trouble and 
suffering. 

Treatment. 

The retraction caused from a cicatrix, and, in most cases, 
those of abnormal development, can not be remedied, and we 



694 EATON ON DISEASES OF WOMEN, 

have to content ourselves with drying up the milk in the 
breast so affected. This can usually be accomplished with 
alternate bathing of the breast with Camph. and Bell, every 
two hours. Those cases caused by pressure can many times 
be relieved by the frequent use of the breast pump. Kent's 
metallic nipple shield and cartouch teat is the best invention 
for use in these cases. It is very simple, free from rubber 
tubing, is easily cleansed, adheres firmly to the breast with- 
out causing constriction of the nipple or of the lactiferous 
ducts. 

Milk Fever. 

The term milk fever is applied to a slight fever which 
usually affects the parturient woman on the third day after 
delivery; sometimes, however, coming on a little earlier. It 
is connected with the activity about to be established in the 
mammary glands, causing the secretion of milk in them. 
When moderate, we can but consider the increased activity 
of the circulation at this time only as a physiological 
condition. The student needs to note this, as otherwise he 
might be unnecessarily alarmed at the symptoms manifested 
at this time. 

Sometimes there is a slight 'chill experienced by the 
patient on the second or third day. This usually lasts but a 
few moments, and is followed by heat, flushed face, increased 
rapidity of the pulse, dry skin, etc. This fever may last 
several hours (usually from four to six) ; but sometimes it 
continues all day. The development of the milk in the 
breast is usually followed by a cessation of the feverish 
symptoms, and they do not return. 

The secretion in the breast previous to the development 
of milk is termed colostrum. It is a watery fluid, slightly 
milky in appearance. When nursed by the child it seems to 
affect the bowels and cause them to act. In exceptional 
cases, milk is secreted in the breasts for months before 
confinement. 



MILK FEVER. 695 

Etiology. 

The causes of this fever seem to be, the congestion in 
the breasts, preceding the secretion of milk, and the sympa- 
thetic nervous excitation induced by this condition. 

Diagnosis. 

A little care needs to be exercised in the diagnosis, as it 
is possible that " Puerperal peritonitis" might come on at this 
period ; or the patient might be suffering from some other 
condition which produces fever, and we might be at fault in 
passing the whole matter by as of little moment. Es- 
pecially should we be careful in the diagnosis, when the 
fever is very high, or the chilly sensations return; and, also, 
when Ave find tenderness and distension of the abdomen, or 
very great tumefaction or tenderness of the breasts. 

An overloaded stomach, incipient pneumonia, etc., may 
cause the high fever at this time; and we need to recognize 
these conditions if present, and treat the case accordingly. 

Treatment. 

Generally speaking, milk fever needs no treatment. After 
confinement the child should nurse from the breasts twice a 
day the colostrum found there ; and the patient's diet should 
be very bland, consisting of gruel or toast, with a little warm 
milk, etc. No meats or soups should be allowed before the 
fourth or fifth day. Cold should be carefully avoided. A 
few doses of Bell., 6 X or 30 x , may be given with good effect, 
and is usually the only remedy indicated. 

Milk Abscess, Mammitis, Mastitis, or Weed ; sometimes termed 
Ephemera, Galactocele, Abscess of the Breast, Mammary 
Abscess, Broken Breast, etc. 

The terms ephemera, galactocele, or weed are applied to 
an attack of inflammation of the breasts, which subsides in 



096 EATON ON DISEASES OF WOMEN. 

a, day or two without suppuration; while the terms mam- 
mary abscess, abscess of the breast, and mammitis are ap- 
plied to those cases of inflammation of the mammary gland 
w T hich progress for some days, and tend to the development 
of pus. 

Symptoms. 

The attack of mammary abscess is ushered in with a chill 
much like an ordinary intermittent, followed by fever, and 
generally ending in perspiration. The breasts are swollen, 
tender, and very hard, especially in some particular part. At 
first this hardness and tumefaction is confined to a small space 
in many cases, but gradually, and sometimes rapidly, extends 
and enlarges, so as to embrace the half, and sometimes the en- 
tire, breast. Intense pain in the head, forehead, and eyebrows 
is complained of; the face is flushed; mouth and tongue 
dry; pulse hard and rapid. The secretions of the kidneys, 
liver, etc., as well as the mammary glands, are suppressed. 
There is sometimes delirium; at other times, great despond- 
ency and fear of death. 

If the inflammation goes on for several days softening is 
observed, which gives indication of the formation of pus. This 
is also signalized by the occurrence of a chill. In a week 
or so, if not artificially evacuated, the pus finds its way to 
the surface by ulcerative action, and breaks through the skin 
in one or several places. This has given rise to the term 
'•broken breast." During this time the pus is finding its 
way to the surface the intensity of the pain in the part is 
very great. 

These attacks of inflammation of the breast are not 
peculiar to the period immediately following delivery, but 
may occur at any period during lactation, the most usual 
time, however, being during the first few months. Some- 
times, 'tis true, they occur during the first week after de- 
livery, and a little care is necessary then to discriminate 
between the attack of milk fever, puerperal peritonitis, and 



ABSCESS OF THE BREAST. 697 

inflammation of the breast. The use of ordinary skill and 
care will, however, make the correct diagnosis easy. 

Htiology. 

Cold is the most frequent cause of these conditions of 
the breast, the cold in the breast causing an arrest of the 
lacteal secretion, or its retention in the lactiferous glands, 
from obstruction in the iiibidi lactiferi, causes inflammation, 
enlargement, and tenderness of the breast, as just enumerated. 

Treatment. 

Bell, internally, and locally applied externally to the 
breast, is the remedy to abort the disease, keeping the 
breast warm, and applying warmth to the extremities. If 
in spite of this treatment the disease goes on to suppuration, 
poultices of flax-seed meal or slippery-elm, applied warm and 
continuously, are useful in softening the hardness and help- 
ing to invite the ulceration towards the surface. When the 
fluctuation is very distinct it is best to lance the abscess, 
and thoroughly evacuate all the pus, and then apply com- 
pression in such a way as to cause all the matter to freely 
pass out and cause adhesions of the walls of the sac. This 
can sometimes best be done with long strips of adhesive 
plaster; at other times with bandages, always taking care to 
leave an opening for the free exit of all pus that may be 
formed. Merc, iod., Hepar sulph., or Ars. iodid. are very gen- 
erally indicated in the suppurative stage; and afterwards we 
must prescribe remedies according to the particular condition 
of each case. 

Malignant and Non-malignant Tumors of the Breasts, Indu- 
ration, Gangrene, Hypertrophy, etc. 

Various tumors develop in the breast, of both malignant 
and non-malignant varieties. 

Gangrene of the breast is seldom seen, and only occurs in 



698 EATON ON DISEASES OF WOMEN. 

women of broken down constitution, and usually in those 
only who are also affected with scrofulous or syphilitic dis- 
ease, entailing an impoverished condition of the blood. Gan- 
grene has been known to be occasioned by the protracted use 
of Ergot by women of middle age. 

Hypertrophy of the breast may affect the entire gland or 
only a part. It consists of simple enlargement of the normal 
structures of the gland. It is chiefly troublesome on account 
of its increased weight, and the patient may demand its 
amputation for this reason. 

Non-malignant or Benign Tumors of the Breast. 

These are lacteal, sero-cystic, hydatid, and adenoid. 

The lacteal tumor of the breast results from an obstruc- 
tion in the lactiferous ducts, and we have treated of it under 
the head of abscess of the breast, though strictly a milk 
tumor is not an abscess (as it contains milk instead of pus). 
The quantity of milk sometimes contained in a lacteal tumor 
is astounding. Dr. W. Parker* reports a case where three 
quarts of fluid were evacuated at one time from one of these 
tumors. The swelling in these cases commences usually 
within three weeks after delivery, and very soon shows fluc- 
tuation. There is little tenderness or inflammation in the 
breast, but the sub-cutaneous veins are enlarged and dis- 
tended. Sometimes the milk is partially absorbed and car- 
ried into the circulation, leaving a residue of thick creamy 
or cheesy matter. This becomes encysted, and may remain 
for a long time as an indurated tumor, without giving any 
trouble to the patient. 

Treatment. 

Where the milk tumor is of considerable size and on the 
increase, it should be evacuated with a trocar, and then 
injected with a Solution of Iodine, about 5 grs. of Iodine and 
15 grs. Potass, iodide to the s of water. After being injected, 

* Gross' Surgery, Vol. II, page 911. 



TUMORS OF THE BREAST. 699 

and the injected fluid has passed away, we should compress 
the breast with adhesive plaster or bandages carried over the 
shoulder and around the body, so as to bring the walls of the 
abscess in contact to promote their adhesion. Small tumors 
of this kind may be left to themselves, or we may give 
Bell., Merc, iodid., etc., internally, and apply Iodine or Camph. 
externally to promote their absorption. 

Adenoid Tumors, Indurations, etc. — This form of tumor 
occurs in the young unimpregnated woman, either in the 
married or single. It produces no constitutional effect. It 
is a hard, indurated, irregular tumor, varying in size from the 
very small tumor not larger than a hazelnut to the size of a 
child's head. When removed by operation it creaks under 
the knife. The tumor is inclosed in a capsule of condensed 
cellular tissue, and is composed of a pale grayish, blue, or 
brownish homogeneous substance. Bluish veins are seen over 
its surface, but it occasions little or no pain or inconvenience, 
except from its weight, in case it is of large size. 

Treatment. 

Adenoid tumors require no treatment unless they attain 
large size, when their extirpation is advisable. Local appli- 
cations and internal medication are of no avail in this form 
of tumor. 

Sero-cystic Tumors op the Breast. — Sero-cystic tumors of 
the breast occur in women usually between the twentieth and 
fortieth years of their ages. They often attain great size. 
They do not produce constitutional symptoms, and there is no 
sympathetic enlargement of the axillary glands, as in malig- 
nant disease of the breast. They are not painful, except from 
their weight. Extirpation is their treatment, which is effect- 
ual. They do not return. 

Hydatid Tumors of the Breast. — These are very rare, 
and it is scarcely necessary to more than mention their possi- 
ble occurrence and say that extirpation is the treatment 



700 EATON ON DISEASES OF WOMEN. 

required. It is usually impossible to diagnose them till after 
removal or by examination of their contents after making an 
incision into them, when they are found to consist of innu- 
merable minute cysts. They do not cause enlargement of the 
axillary glands, cause pain at night, or produce constitutional 
disturbance. After thorough excision they do not return. 

Fatty Tumors of the Breast. — Fatty tumors of the 
breast are exceedingly uncommon. Gross relates but one 
case, and that one from Broclie. This was situated back of 
the gland and pushed it forwards. The only remedy is 
extirpation. Dr. Gross* says: "I would suggest the Bantam 
system of diet in such a case. Allow the patient no cream, 
butter, sugar, milk, or fat meat, or starch; but let her eat 
lean meat, fish, all vegetables, except potatoes and beets, and 
all kinds of fruit. Allow acidulated drinks." This plan of 
diet is calculated to rapidly reduce the adipose tissue in any 
case; and we believe it might be found to have a salutary 
effect upon fatty tumors of the breast, though we have never 
tested it in such a case. 

Cancers or Malignant Tumors of the Breast. 

The most common malignant tumors of the breast are 
the scirrhus (or hard cancer) and encephaloid. Melanosis 
and colloid are occasionally found. 

Scirrhus of the breast sometimes occurs after the climact- 
eric period is passed. It has been known to develop in 
women from seventy to eighty years of age. Isolated cases 
are reported where it has affected young girls, even as 
young as twelve years. I removed one breast for scirrhus 
in a lady but twenty-four years of age. Such instances are, 
however, extremely rare. Spinsters are liable to the dis- 
ease as well as the married. The left breast is affected 
more frequently than the right. 

* Gross' Surgery, Vol. II., p. 914. 



CANCER OF THE BREAST. 701 



Symptoms, 



The patient usually complains of sharp lancinating pains, 
occurring mostly at night, in one breast. On examination, 
there is found an indurated tumor of small size, uneven, 
and nodulated. The axillary glands of the corresponding 
side are found enlarged and tender, and the patient exhib- 
its the sallow, tawny complexion characteristic of the can- 
cerous cachexia. The disease progresses very slowly; by 
degrees the nipple is found to be more and more re- 
tracted, the tumor enlarges, and blue veins are seen over its 
surface. 

In some instances, scirrhus commences in the integument 
of the breast, or the underlying cellulo-adipose tissue. In 
the former case, it is of very small size, bluish in color, 
round and movable. When situated in the cellular tissue it 
is felt deep-seated, though movable, generally oblong and 
nodulated ; after several months it approaches the surface, 
the tumor becomes fixed, the nipple retracts, the skin over 
it becomes bluish, and sloughing commences, and a foul, 
irritable fungous opening is established. This results from 
all forms of scirrhus sooner or later. 

Encephaloid or Soft Cancer. — The soft or encephaloid 
cancer of the breast is much more uncommon than the 
scirrhous, or hard cancer, just described. This form of cancer 
develops rapidly in comparison with the hard' variety, often 
in a, few months attaining the size of a child's head. The 
tumor commences deep in the substance of the breast, and 
soon ulcerates, and throws out a sort of fungous growth. 
The pain is comparatively slight in encephaloid, conrpared 
with scirrhus. The constitutional disturbance is. however, 
marked, and the cancerous cachexia is unmistakable. Death 
generally brings relief in from six to ten months from the 
time ulceration commences. 

Colloid, alveolar or gelatiniform, cancer in the breast is 



702 EA TON ON DISEASES OF WOMEN. 

seldom met with. It is of sIoav development, is of a grayish 
color, dense, firm, glistening. 

Melanosis of the breast occurs sometimes in connection 
with scirrhous cancer. It consists of an infiltration into the 
cellular tissue of material of a dark, sooty color, which 
hardens into nodules. These deposits have a tendency to 
suppuration, and usually return after removal. 

Treatment. 

In all varieties of tumors of the breast (except the fatty) 
a generous, unstimulating diet is to be given. Hygienic meas- 
ures are to be rigidly enforced. In the non-malignant varie- 
ties of these tumors we may expect a cure, either with 
medicine or by surgical operation. In simple hypertrophy 
Iodine in the 4 X dilution (or ten-thousandth potency) is an 
efficient remedy; or we may sometimes find that Ars. iodid. 
is more clearly indicated. These remedies, as well as Phy- 
tolac. dec, may reduce the size of either variety of the non- 
malignant tumors of the breast. 

In the cancerous, or malignant, tumors we can not expect 
a cure with either remedies or by surgical means. Remedies 
must be used according to the homoeopathic indications in 
each case. Among the remedies most frequently indicated 
we will find Ars., Apis, Conium, Macrotis, China, Nux, Bry., 
Sidpli., etc. 

Amputation of the Breast, or Exsection of the Tumor. — 
In the malignant tumors of the breast it is of but little use 
to operate, for at best the disease is sure to return in a few 
years. Removal of the growths with caustic paste is also 
just as unsatisfactory. The removal of the whole or a part 
of the breast in cases of large, hard, non-malignant tumors 
of this gland is often advisable. 

Operation. — The patient is to be placed under the influ- 
ence of an anaesthetic, and then placed upon the operating 
table. The incisions should be made in the skin of an ellip- 



AMPUTATION OF THE BREAST. 



703 



tical shape, so that when the tumor is removed the integument 
may be brought together, and have no redundancy. 

The first incision should be in the direction of the fibers 
of pectoralis major muscle, if possible (sometimes, owing to 
the position and shape of the tumor, this rule must be ig- 




Fig. No. 64.— Operating Table. 

nored), and should encircle the lower part of the tumor, and 
should include the skin and cellular tissue. The tumor 
should now be held up by an assistant while we dissect off 
(he lower flap of integument from the tumor. 

After this is done, we make a similar incision upon the 
upper side of the tumor, and dissect back the flap as before. 
We now grasp the tumor with the left hand, and dissect it 
out with the right, peeling it out as much as possible, using 
the fingers, or the handle of a scalpel, for this purpose, and 
incising such tissues as w T e find we can not lacerate. An 



704 EATON ON DISEASES OF WOMEN. 

assistant should seize any artery we may divide with the 
artery forceps, and use torsion if it be small, or let another 
assistant ligate it, if it be of considerable size. After the 
removal of the tumor, and we have ascertained that all ooz- 
ing of blood has been arrested, w r e may lay the flaps together; 
apply a, compress of soft cloth wet with warm water and 
Arnica; gently apply a bandage, and allow the patient to 
revive. Remove her to her bed, and give Arnica 6 X every 
half hour, unless she sleeps; if so, let her alone, only apply- 
ing sufficient covering to maintain the warmth of the body. 

After six or eiffht hours we remove the bandages and 
compress, and ascertain if there is any hemorrhage, and after 
giving a little Chloroform w^e proceed to fix the flaps in posi- 
tion with interrupted silver wire suture, bringing the ends of 
the ligatures (if any have been used) out at the most de- 
pendent portion of the wound. Apply long adhesive straps 
to support the tissues and prevent strain on the sutures, and 
over these apply a compress and bandage as before, moist- 
ened with Calendula wash or warm water and Arnica. 

No opiates or stimulants are required. Lay the patient 
so that the fluids which may accumulate under the flaps may 
find exit readily. The compress should be removed and 
charged every six hours at most; and Arnica 6 X should be 
given internally every three hours. Gentle, plain nourish- 
ment only should be allowed. The ligatures will ordinarily 
be found loose in about five or six days, when they may be 
removed, as well as the sutures at about this time. If the 
secretions cause the lower flap to pouch down, and they do 
not find exit, we should make an incision at the most depend- 
ent portion, and allow them to drain away. If adhesion of 
the flaps to the muscular tissue of the ribs does not readily 
take place we may inject some Solution of Iodine to stimulate 
granulations and adhesions. We must keep up gentle press- 
ure till the flaps have become adherent. 



PUERPERAL PHLEBITIS. 705 



CHAPTER LXII. 

PHLEGMASIA DOLENS— PUERPERAL PHLEBITIS, OR MILK- LEG. 

This disease is peculiar to women, and is usually con- 
nected with the puerperal state, though phlebitis of the limb 
has been known to affect men,* following ulceration of the 
intestines and disease of the hemorrhoidal veins ; and also 
has occurred in connection with cancer of the rectum. Rams- 
botham,f White, Hewson, Twedie, Cheyne, Ferrion, and De- 
wees mention cases occurring independently of the puerperal 
state ; but to one case occurring independently of the puer- 
peral state there have probably been ninety-nine in connection 
with it. Of late years the disease seems to be less frequent 
than formerly, several late writers having failed to make any 
mention of it. 

An attack of phlebitis usually occurs during the first four 
weeks after confinement, although sometimes later. The 
inflammation is supposed to commence in the uterine veins in 
these cases, and extend to the iliac and crural veins. The 
disease may affect one or both of the lower limbs; generally 
only one is affected, but sometimes it migrates from one to 
the other. Blundell, % Campbell, || and Churchill § state that 
the left limb is most frequently affected. This is my own 
experience, and has also been observed by Ramsbotham.^[ 
The tendency of the disease is to progress to a gangrenous 
condition, especially of the cellular tissue ; in cases where this 
is affected, ulceration at some point being a not uncommon 
result. It seldom, if ever, attacks the same limb twice. 

*Lee, page 163. tRarnsbotham's Obstet., page 490. 

J Obstetricy by Costle, page 786. |l System of Midwifery, page 371. 
§ Midwifery, page 462. f Obstet., page 488. 

45 






706 EATON ON DISEASES OE WOMEN. 



Diagnosis. 



The symptoms in a case of phlegmasia dolens, or puer- 
peral phlebitis, are very much the same as in ordinary inflam- 
matory attacks — the rigor followed by heat, fever, etc. The 
wiry pulse is sure to be present in the early days of an 
attack; the pain, however, is only moderate in the pelvis, 
and is severe in one of the lower limbs. 

On examination of the limb we find it much swollen, 
especially in its upper part — the foot and ankle remaining 
normal in most cases, but the calf of the leg is generally 
somewhat affected. The swelling is hard and slightly elastic 
to the touch; the color of the integument of the affected 
limb is white and glossy, The distension of the tissues is 
sometimes enormous. 

For a day or two preceding the swelling of the limb, in 
some cases, we may feel the inflamed veins in the upper part 
of the limb like cords, as hard as tendons. The swelling is 
distinguished from dropsy in not pitting on pressure. It is 
not red and shiny like erysipelas, but w r hite and glossy. 
As the disease progresses the fever and pain abate, the 
swelling becomes less tense, the tissues commence to pit on 
pressure. 

In bad cases dark spots appear in several places, varying 
in size from a half dollar piece to the palm of the hand, 
and sloughing sometimes takes place. There seems to 
be a great variety in the seat of the inflammation, some- 
times affecting the internal coat of the veins, and giving 
rise to the formation of pus, in which case the symptoms of 
pyaemia are manifested. The case then assumes typhoid 
symptoms, and the outcome is doubtful. In other cases the 
outer coat of the veins is mostly affected, and the inflamma- 
tion extending to the cellular tissue, gives rise to a great 
amount of effusion of lymph and serum, though the case may 
not be as dangerous to life as when the internal coat of the 



PUERPERAL PHLEBITIS. 707 

veins is affected, though in the latter case there is much 
less swelling. 

Etiology. 

The disease evidently in most cases commences in the 
uterine veins, and their large distension seems to predispose 
to an attack. Those cases which have been affected with 
post partem hemorrhage are most liable to the disease; 
not, I think, so much that the hemorrhage causes the inflam- 
mation, as that a condition of atony and dilatation of the 
veins causes both the hemorrhage and the attack of phle- 
bitis, the immediate or exciting cause being cold, arrest of 
insensible perspiration, glandular action, etc. 

I need not occupy space and time in noting the various 
theories which have been held regarding this complaint 
since the commencement of the history of medicine. Suffice 
it to say, that the profession is now well satisfied that the 
disease is one of inflammation of the veins primarily; and 
secondarily, of the cellular tissue of the limb. The oedema, 
or rather great enlargement followed by oedema, is due to 
obstructed circulation in the veins. To Dr. David Davis * 
we are indebted for elucidation of the pathology of the dis- 
ease, aided in later years by Dr. Robert Lee. It is my 
duty to say, that the disease has been occasionally caused 
by suppression of menstruation and cold, causing inflamma- 
tion of the veins of the uterus and limb ; also, in a few in- 
stances of malignant disease of the womb crural phlebitis 
has resulted. These cases are, however, exceedingly rare. 
Post-mortem Appearances. — The crural and femoral 
veins are found obliterated, and converted into cords in 
some cases. In others, pus is found in the hypogastric, 
common iliac and femoral veins. In cases where sloughing 
had occurred, the femoral vein was obliterated. The iliac 
glands are sometimes found inflamed, and sometimes con- 
verted into abscesses. 

* Reports Medico-Chimrgical Society, Vol. XII, p. 419. 



708 EA TON ON DISEASES OF WOMEN. 



Treatment. 

Aconite and Secale cor. are indicated in the outset, either 
singly or in alternation, followed by Bell, or Bry. Evacuat- 
ing the bowels with enemse of tepid water, and putting the pa- 
tient into a warm pack, are very useful adjuncts. We should 
keep the lower part of the body and limbs well wrapped in 
flannel. In some cases Merc, Ars., Rhus, CarboL acid, etc., 
are indicated. 

Indications for Remedies. 

Aconite, for the wiry pulse; chilliness; fever; restless- 
ness ; dizziness ; dry, hot skin, etc. 

Ars. Alb., for great prostration; alternating heat and 
cold ; aching of the limbs ; restlessness ; thirst ; nausea ; (Ede- 
matous swelling, etc. 

Bell., for dullness of sensation; intolerance of light or 
noise. 

Bry., for sharp, cutting pains in the affected limb. 

Carb. Ac, in a tendency to suppuration; great exhaus- 
tion (used in 6 X dilution). 

Merc. — Dry, shiny skin; torpidity of the secretions; 
diarrhoea; weakness, etc. 

Rhus. — Exhaustion; pain while still, relieved by motion; 
inability to move the affected limb, etc. 

Secale Cor. — Numbness and coldness of the limbs ; diar- 
rhoea; stupid condition of the brain (Cowperthwaite). 

If a slough forms, a poultice of yeast is to be applied; 
and after the dead tissue is separated Vaseline may be ap- 
plied to the sore, and the whole lower part of the limb 
should be bandaged with a roller applied evenly and gently, 
commencing at the foot, and applying the bandage upwards. 
The limb should be kept elevated upon a hard pillow. 



SUB-INVOLUTION OF THE UTERUS. 709 



CHAPTER LXIII. 

HYPERTROPHY, AND SUB-INVOLUTION OF THE UTERUS. 

Hypertrophy of the uterus is a condition of chronic en- 
largement or thickening of its tissues. Sub-involution is ap- 
plied to the chronically enlarged uterus following the delivery 
of a child or foetus. It may either follow confinement at full 
term, premature delivery, or abortion. 

The uterus after impregnation seldom becomes reduced to 
the size of the organ in the virgin state, except in old age ; 
but the enlargement above the normal condition is but slisht — 
about one-half an inch, as a rule. While the virgin uterine 
cavity measures about two and one-half inches, the uterus 
after impregnation seldom measures less than two and three- 
fourths or three inches, after the uterus has been emptied of 
its contents, and complete involution has taken place. The 
uterus must, then, show a measurement in excess of three 
inches before we can term it hypertrophied, or call it a case 
of sub-involution, and then we can not where the elongation 
is due to hypertrophy of the cervix. 

Sub-involution is one of the most common conditions 
which we find among the ailments of women, and demands 
more attention than is usually given the subject (for several 
authors on " Diseases of Women" have entirely ignored it, 
while others have given it but a page or two). It causes 
many of the cases of leucorrhoea, displacements, symptoms 
of spinal disease, mental hallucinations, dyspeptic symptoms, 
etc., etc. 

Chronic sub-involution and hypertrophy of the uterus are 
usually accompanied with a low grade of chronic inflammation, 
termed chronic metritis, or areolar hyperplasia. This inflam- 



710 



EA TON ON DISEASES OF WOMEN. 



mation often extends to the ovaries and peritonaeal membrane, 
as well as the cellular tissue. In this condition the body and 
cervix of the uterus are both usually affected about alike; 
but in some instances the fundus alone is affected, the cervix 
being normal. Where the cervix alone is enlarged the dis- 
ease is termed hypertrophy of the cervix, and is treated of 
separately by most authors. I shall follow the usual plan of 
nomenclature, and intend that the reader shall understand 
that by hypertrophy of the uterus we mean either enlarge- 
ment of the whole organ or the fundus. 



Symptoms. 

The symptoms characteristic of hypertrophy, we can only 
positively ascertain by the aid of the uterine sound, which 
will show an elongation of the entire uterine canal; and at 
the same time we note the absence of elongation of the 
cervix uteri. Besides this distinctive symptom, we have 

thickening of the walls 
of the uterus, to be de- 
termined by pressing 
one hand above the 
pubis, while the sound 
is introduced with the 
other to the fundus. 
When the disease af- 
fects both the body 
and cervix 7 we feel the 
cervix thickened and 



enlarged in all direc- 




Fig. No. 65 —Sub-involution, with Procidentia of 
thic Uterus. 



tions, but more promi- 
nently in a lateral di- 
rection, though occasionally it is also much elongated. In 
introducing the sound, the expert notices the internal open- 
ing of the cervical canal into the body of the uterus by its 
more contracted condition; and if we withdraw the sound, 



SUB- INVOLUTION OF THE UTERUS. 711 

and observe the length of the cervix, and again measure the 
cervix and body together,* 'we can determine the relative en- 
largement of both or either, as the case may be. In these 
eases there is usually a feeling of weight in the pelvis, a 
bearing down sensation often in both back and boAvels. Def- 
ecation is usually difficult; and frequently dysuria is com- 
plained of. Usually a leucorrhoeal discharge is present, 
which stains the linen worn a yellow color, though it may 
appear white as it emerges from the vaginal orifice. Usually 
in cases of hypertrophy the uterus is lower in the pelvis 
than normal, owing to its increased size and weight. (See 
Fig. No. 65.) 

Retro-flexion or ante-flexion is quite frequently found 
to complicate these cases, the former being more common 
than the latter. 

Etiology* 

The cause of hypertrophy is most frequently inflamma- 
tion, sometimes, it is true, moderate in degree, but, never- 
theless, inflammation, or a condition of areolar hyperplasia, 
causing gradual enlargement from effusion of plastic material 
into the interstitial tissue. These inflammations which give 
rise to hypertrophy are caused by cold at the menstrual period, 
excessive venery, the use of remedies to prevent conception 
or produce abortion, rising too soon and taking cold after a 
miscarriage, the retention of a small portion of the placenta, 
cold baths, and cold vaginal injections, caustic applications to 
the os uteri, the wearing of improper and ill-adjusted pessa- 
ries, tight lacing, excessive dissipation, over-work, heavy 
lifting, suppressed menstruation, uterine tumors, etc., etc. 

The cause of sub-involution is supposed to be an atonic 
condition of the system, and especially of the nerves of the 
pelvis, causing want of firm, muscular contraction after deliv- 
ery, leaving the uterus flabby, tending to produce flexions, 
and with all the blood-vessels dilated there is a tendency 



712 EATON ON DISEASES OF WOMEN. 

to favor congestion and effusion. We find in women who are 
exhausted. with frequent gestations and lactations a greater 
liability to this disease than in those of robust health. 
Laceration of the cervix in labor is also a fruitful cause 
of hypertrophy and sub-involution of the uterus. (Refer- 
ence to the chapter on Lacerations of the Cervix will more 
fully explain). 

Treatment. 

The first thing to do in the treatment is to remove the op- 
erating cause, if it can be ascertained. The next is to rectify 
any flexion or version which may complicate the difficulty. 
Little can be done to remove the hypertrophy or the symp- 
toms accompanying it until this is done. With this accom- 
plished we may observe great benefit from the use of Secede, 
Nux, Sepia, Bell., loci, of Ars., A?°s. of China, or Kali iod., 
given homoeopathically, in accordance with the totality of 
the symptoms in the case. In some instances these remedies 
will prove curative by establishing an activity of the absorb- 
ents, and producing contraction of the blood vessels and mus- 
cular tissue as well as tonicity of the nerves of the uterus 
and the entire system, thereby strengthening digestion and 
assimilation as well. 

Regarding local treatment great diversity of opinion ex- 
ists, some claiming that local treatment is of no use, others 
relying upon it almost, if not quite, exclusively. My own 
experience is in favor of a combination of local and general 
treatment, using both internal remedies as indicated, and also 
some local treatment. The local treatment should be varied 
according to the condition of the uterus. 

If somewhat tender and soft, compressible and spongy to 
the feel, I get fine results from the application of Glycer- 
ine and Hydrastis Tr., equal parts, applied directly to the 
cervix by means of a, cotton wad inserted in the vagina, or 
by inserting a sponge tent, partially moistened with the same 
medicine, into the cervical canal. This treatment causes 



SUB-INVOLUTION OF THE UTERUS. 713 

a drainage of the serum from the parts. The sponge tent 
compresses the capillary circulation and repels its activity, 
thereby reducing the congestion and size of the organ. Tents 
may be used made of cloth wound around bonnet wire, in 
shape like the ordinary sponge tent. These may be satu- 
rated with the same medicine, or Glycerine and a Solution of 
Iodine or Comp. Tr. Iodine, and inserted well up into the 
fundus uteri. These tents are highly recommended by Pro- 
fessor Hunt, of Covington, Kentucky, and I can add my own 
and many others' experience in favor of their efficacy in 
some cases. 

Medicated suppositories have long been used by the allo- 
pathic profession, and an effort is being made by the manu- 
facturers to inveigle the homoeopathic profession into their 
use. We are sorry to say that we think more zeal than 
wisdom is manifested by some physicians in advocating them. 
Remedies may be more readily administered by the mouth 
than the os uteri in most instances ; and they are not likely 
to cause as much injury given in proper attenuation by the 
first named method. We feel that administering remedies 
via the os uteri as a rule (which some would seem to desire 
should become a general practice) is running gynaecology into 
disrepute. 

We do not say that good may not sometimes result from 
their use. Allopaths have obtained good results from scari- 
fications of the cervix uteri, and from leeching it. Must we 
rush in and adopt such practice just when they are beginning 
to learn better? We think not. Some uteri will not tolerate 
the presence of any substance in the cervical canal without 
being thrown into spasmodic contraction, causing the patient 
great pain. The suppositories sometimes do this. This is 
one objection to them; another is, their expense; and, 
thirdly, they are unnecessary. 

We feel it our duty to say this to the student,- although 
the experienced gynaecologist will occasionally find a case of 



714 



EATON ON DISEASES OF WOMEN. 



well dilated cervix where the local application of some rem- 
edies like. Glycerine, Hydrastis, Belladonna, or Iodine may be 

tolerated, and in a few cases 
may act beneficially in this 
form. They are not so very 
easy of introduction, as has 
been stated by interested 
parties. A well dilated os 
uteri is necessary in the ap- 
plication of any intra-uter- 
ine medication. With a 
soft, long-handled brush we 
may apply these remedies 
to the cervix conveniently; 
and in most cases this is 
the preferable plan in the 
treatment of hypertrophy 
or sub-involution. In some 
cases of hypertrophy and sub-involution there is absence of 
tonicity and sensibility, a want of feeling instead of tender- 
ness. In these cases I use electricity as a stimulant, using 
a. gentle current with the uterine electrode in the uterus, and 
the other electrode to the spine, gently increasing the cur- 
rent till it is felt by the patient in some small degree, then 
allowing it to pass steadily for about three minutes, using this 
treatment once in three days ; sometimes for two weeks, 




Fig. No. 



Faradic Battkky. 



G.TIEMANN-CO. 




Fig. 67. — Intra-uterine Electrode. 



omitting the electricity and applying Tr. Iodine Comp. to the 
cervix with a soft brush, and introducing it into the cervical 
canal with a probe covered with cotton and saturated with 
the wash. 



SUB- IX VOLUTION OF THE UTERUS. 



715 




Palmer's Uterine Applicators. 



Professor Palmer, of 
this city, has invented a 
set of uterine applicators 
which makes the applica- 
tion of remedies to the 
intra-uterine surface quite 
easy and thorough. (See 
Fig. No. 68.) The right 
hand figure represents a 
tube with a handle, which 
is to be introduced into 
the cervical canal after 
having placed in it the 
plug printed beside it. 
This rounds the extremity 
of the tube and renders its 
introduction easy, when 
the canal is well dilated. 
We now withdraw the 
plug and introduce the 
sponge saturated with the 
medicine by means of the 
long sponge holder, as seen 
in the next figure ; or we 
may wrap the probe (figure 
to the left hand) with raw 
cotton, saturate it with the 
medicine, and apply to 
the intra-uterine surface 
through the tube first men- 
tioned. Without the tube 
we may apply the medi- 
cine thoroughly to the cer- 
vix, and with it, to the in- 
terior of the fundus. 



716 EATON ON DISEASES OF WOMEN. 



CHAPTER LXIV. 

HEMATOCELE, PELVIC HEMATOMA, THROMBUS, ETC. 

It is now only about twenty years since hematocele has 
been at all well understood by the profession; although as 
early as 1843, M. Velpeau had the honor to diagnose the 
disease during life, without making an explorative incision. 

Hematocele, sometimes denominated thrombus, pelvic 
hematoma, peri-uterine hematocele, etc., consists of a blood 
tumor or effusion of blood into the peritoneum, or into the 
cellular tissue of the pelvis. Its location is usually posterior 
to the vagina; and, I think, most frequently, in Douglas cul- 
de-sac. 

Source of the Hemorrhage. — Bernutz and Trousseau sup- 
posed the hemorrhage to be from retained menstruation, 
flowing back through the Fallopian tubes into the peritoneum; 
but this view is untenable, as there is suppression in but few 
cases of hematocele, and it is now well understood that the 
contents of the distended uterus will not pass through the 
Fallopian tube readily. The hemorrhage may come from the 
bulb of the ovary or from the rupture of the Graafian follicle 
in some cases, which, though usually producing no hemorrhage, 
may do so from the rupture of a small blood vessel; in this 
case, the blood would be contained in the peritoneum. If it 
arise from the pampiniform flexus, between the folds of the 
broad ligament, or from about the vaginal junction with the 
uterus, the blood will be contained in the cellular tissue. 

Etiology. 

Hematocele is most common in women who are exhausted 
from frequent gestations, and those who labor, the rich 



HEMATOCELE. ' 717 

being seldom affected. The unmarried and barren are also 
seldom affected. I have, however, seen one case in a lady 
forty-two years of age, who had always been barren, though 
married over twenty years. It occurs generally during the 
woman's greatest genital activity. 

The laceration of a sort of false membrane formed over 
the ovary, as a result of peri-metritis at the time of the rup- 
ture of a Graafian follicle, may cause this hemorrhage. Rup- 
ture of the distended ovary is another cause which may 
produce hematocele. ' Generally occurring at the period, or 
just following a normal menstruation, it is apparently con- 
nected with this function; usually, in my own experience, 
caused by straining or hard work while menstruating, when 
the pelvic blood vessels are distended with blood. It is not 
strange that some severe exertion might lacerate some of 
them in this condition. Excessive coitus has appeared to 
cause hematocele in some cases. The hyperemic condition 
of the system may predispose to the disease, as well as a 
condition of extreme impoverishment of the blood, and the 
condition called purpura hcemorragica. 

Symptoms. 

The occurrence of an effusion of blood into the peritoneum, 
or into the cellular tissue of the pelvis, produces the faint- 
ness which any other great loss of blood would induce, pre- 
ceded in some instances by severe, lancinating pain in the 
pelvis. This pain in the pelvis is more or less constant for 
some days. There is often vomiting and considerable fever. 
The face exhibits a shrunken, cadaverous appearance; the ex- 
tremities are cold; pulse rapid, weak, and sometimes almost 
imperceptible. There is usually constipation, but the consti- 
pation is sometimes accompanied with a distressing tenesmus. 

On making a digital examination per vaginam, we detect 
the pelvis filled almost entirely, or in part, with a smooth 
mass, generally situated in the posterior part, and between 



718 EATON ON DISEASES OF WOMEN. 

the vagina and rectum. This is called a retro-uterine, or 
recto-vaginal, hematocele when the tumor consists of blood. 
Sometimes we find the mass seems to surround the vagina, 
and it is then called peri uterine hematocele. In case the 
tumor occupies the entire posterior part of the pelvis, as 
represented in Plate XXVIII, it shows that the blood is 
infiltrated into the cellular tissue. 

In case the effusion is into the peritonaeum, and the 
blood gravitates into Douglas cul-de-sac, the tumor is found 
higher in the posterior part of the pelvis, behind the cervix 
uteri, and feels circumscribed. Sometimes we may feel fluc- 
tuation, and sometimes we can not, depending upon the 
amount and condition of the effusion. 

When the effusion is into the peritoneal cavity it may, 
after filling the lower portion of the abdomen, extend up- 
wards, even reaching to the umbilicus. 

It will be observed by this description so far, that hemat- 
ocele is only a, symptom of an effusion of blood, and that 
the cause of the effusion, and the exact locality of the point 
from which it comes, is often very obscure. Hence, we name 
the condition as hematocele, though not a disease in itself 
per se. As time passes the symptoms in most cases moder- 
ate, although there may be more tenderness in the vagina for 
a time, and a considerable febrile condition. In other in- 
stances we have symptoms of acute inflammation in the 
pelvis, resulting in the formation of a pelvic abscess some- 
what similar to that occurring in cellulitis. Extreme sensi- 
tiveness of the stomach is one of the most constant symptoms 
of these cases. There is also often much cystic irritation, 
the urine either being passed with difficulty or frequently 
with much pain. Sometimes the use of the catheter is de- 
manded in these cases. 

Prof. Byford* gives to this accidental hemorrhage the 
term Metatithmenia, signifying misplaced or vicarious men- 

* Byford on "Diseases of Women," p. 101. 



Plate XXVIII 




RECTO-VAGINAL, OR PELVIC HEMATOCELE, WITH ELEVATION 
OF THE UTERUS. 



PELVIC HEMATOCELE. 719 

struation. But as this term would indicate a suppression of 
normal menstruation it is not applicable, as there is suppression 
of the catamenia in very few cases of hematocele. 

Hematocele may occur several times in the same patient. 
Dr. By ford has seen over twenty attacks in one patient dur- 
ing a period of seven years. Sometimes women suffer from 
slight hemorrhages of this character at nearly every menstrual 
period ; and the presence of this effused blood in the vicinity 
of the ovary gives rise to a burning pain, hot flashes, and 
general sympathetic disturbance of the entire system, con- 
sisting of backache, headache, general nervousness, palpita- 
tion, nausea, etc., etc. In some of these cases it is hard to 
differentiate between them and ovaritis, or mild peri-metritis. 
Still, the significant symptom will be found to be the occur- 
rence of fainting, which does not ordinarily take place in the 
other disease just mentioned; and the attack is usually after 
the menstrual flow has ceased, corresponding to the time of 
the rupture of the Graafian vesicle, which occurs soon after 
the menstrual flow. 

Differential Diagnosis. 

The differential diagnosis between pelvic hematocele and 
cellulitis, pelvic abscess, retro-version of the uterus, ovarian 
cystoma, etc., deserves some attention. The onset of the attack 
with faintings occurring without much, if any, premonition, is 
very characteristic of hematocele (but might be a sjnnptom 
of cardiac disease). The attack of cellulitis occurs with 
chilliness, soon followed with heat and fever, accompanied 
with the similar pain as in hematocele. In hematocele the 
face is blanched and cadaverous, in cellulitis it is flushed and 
plump ; pressure upon the tumor of hematocele through the 
vaginal walls causes little pain if examined soon after the 
attack before cellulitis complicates the case. 

In cases which are complicated with cellulitis and the 
formation of an abscess, we have to depend largely upon the 



720 EATON ON DISEASES OF WOMEN. 

history of the case for differential points. The slow growth 
of ovarian cystoma and its height in the pelvis, with its devel- 
opment in the abdomen, will distinguish it from hematocele, 
being free from the symptoms of faintings and severe pain. 

If retro-flexion of the uterus is suspected, we had better 
make an effort to rectify the misplacement; if menstruation 
has been recent we may at once pass the sound, and discover 
in a few moments the nature of the case. I was recently 
called to see the wife of a physician who had had the counsel 
of an eminent surgeon a few days before, who had (without 
the aid of the sound) diagnosed retro-version. I immediately 
passed the sound, and found the uterus normal in position, 
and diagnosed a recto-vaginal hematocele (from the history 
of the case and vaginal examination), which was undergoing 
suppurative inflammatory action. My diagnosis was con- 
firmed in a few days by the discharge of the abscess into the 
rectum, followed by relief and health. The violent efforts 
which this consulting surgeon made to replace this tender 
hematocele with his fingers was injurious and painful to the 
patient, and disgraceful to himself. 

In pelvic cellulitis the tumor develops more gradually, is 
more tender on pressure, is generally more diffused, though 
not always. There is some heat in the vagina in cellulitis, 
and very little in a recent hematocele. 

Extra-uterine pregnancy, either ovarian, tubal, or abdom- 
inal, may slightly simulate hematocele. The tubal and ova- 
rian pregnancy may produce hematocele from the laceration 
likely to occur about the third month, and the hematocele in 
these cases may contain a foetus. This is most likely to be dis- 
covered at the autopsy which we will have an opportunity to 
make soon after the laceration occurs. 

Prognosis. 

Generally, the prognosis is favorable. About ninety per 
cent of these cases recover. We have, however, to fear 



PEL VIC HjEMA TO CELE. 721 

adhesions, perforations, exhaustion ; thickening of the walls 
of the uterus, rectum, bladder, or vagina, or severe inflamma- 
tion. Sometimes months are required for recovery, while in 
others the cure is effected in two or three weeks. 

Our prognosis must be modified by the amount of inflam- 
mation, exhaustion, diarrhoea, etc., which is present, diarrhoea 
sometimes supervening upon the condition of constipation 
usually first present. 

Treatment. 

If called to a case of hematocele in its first stage, while 
the hemorrhage is going on, we should at once give Ipecac 
or Aconite, followed in a few hours with Secale, and apply 
cold to the pelvis. But it is not often we are called till the 
hemorrhage has ceased, the tumor of large dimensions in the 
pelvis, and the patient suffering from exhaustion, at which 
time we should select remedies best suited to the condition, 
such as China, Ars., Chi. ars., Nnx, Ignatia, Rhus, etc. Beef 
tea, wine-whey, egg-nog, and the like, should be given, and 
warm vaginal and rectal enemata should be used. Warmth 
should be industriously applied to the extremities and about 
the pelvis. Perfect rest and quiet must be enjoined and 
secured, with good air and the best of nursing. 

Evacuating the effused blood is sometimes demanded by 
the urgency of the symptoms of pain and enormous disten- 
sion, in which case it should be done with a long curved 
trocar, and liquid Persulphate of Iron should be diluted four 
times with water and injected if the blood seems to be still 
flowing from the ruptured vessels. In the great majority of 
cases there is no call for surgical interference; but allowing 
nature to have her way is usually the best practice, aided by 
remedies, diet, and warm vaginal and rectal injections; often 
the effusion is absorbed without producing serious injury : 
whereas, too much interference might cause an increase of 
inflammation, which might result fatally. When suppuration 
takes place (which is characterized by rigors and a feeling 

46 



722 EATON ON DISEASES OF WOMEN. 

of fluctuation supervening on hardness of the tumor), it is 
sometimes advisable to evacuate the pus by a free incision 
of the bistoury through the vaginal wall, the abscess being 
for some reason more liable to point into the rectum and 
leave an internal fistula, or cause pyaemia through the 
absorption of pus into the general circulation. 

The treatment of an abscess caused by hematocele does 
not differ from one caused by cellulitis. The hardness caused 
by coagulated blood, called Thrombus , is more likely to result 
in abscess than where the effused blood does not coagulate, 
and remains fluid. 



Plate XXIX. 




HERMAPHRODITE, OR NONENTITY. 
UTERUS ABSENT. VAGINA SMALL. CLITORIS ENLARGED. 



HYPERTROPHY OF THE CLITORIS. 723 



CHAPTER LXV. 

ELEPHANTIASIS OR HYPERTROPHY OF THE CLITORIS, LABIA 
MAJOR A, AND LABIA MINORA, HERMAPHRODITES, NONEN- 
TITIES, TUMORS OF THE LABIA, ETC. 

Elephantiasis or hypertrophy of the clitoris is quite rare. 
(See Plate No. XXIX.) I hare seen but three cases in an 
experience in hospital and private practice of over twenty 
years. It occurs as a congenital deformity, and as an ac- 
quired affection from diseased action. 

Occurring as a congenital affection, in connection with 
partial atresia of the vagina or abnormal development of the 
uterus, ovaries or vagina, has given rise to the term hermaph- 
rodite, signifying the union of both sexual organs in one 
person, as in these cases the labia are ordinarily developed. 
The term nonentity, we think, would be more appropriate, as 
they certainly can not be considered either male or female. 

■the enlarged clitoris in these cases is capable of little or 
no erection, and can not be used as a copulative organ to any 
considerable extent. A sort of sexual excitement with 
slight erection is sometimes possible, but there is no semen 
secreted or ejaculated. 

On the other hand, we can not consider such persons as 
females, as the absence of the vagina, uterus or ovaries, very 
common in these cases, makes them incapable of copulation, 
or conception, though in case of enlargement of the clitoris 
from disease, the vagina and uterine organs may be perfect, 
and copulation and conception be possible. Such a person 
would, of course, be a female deformed, and not a nonentity 
or hermaphrodite. In one case which I saw the sexual in- 
stinct seemed entirely wanting. In the two other cases it 



724 EATON ON DISEASES OF WOMEN. 

existed somewhat in excess. These were cases of hyper- 
trophy from inflammatory action, one in a lady aged about 
twenty-three, the other over fifty. Neither suffered much 
inconvenience from the enlargement, except a slight irritation 
and soreness at times. 

Nymphomania is said to be, caused by, and be the cause 
of, enlargement of the clitoris, but I have not observed it. 
Dr. C. D. Palmer, of Cincinnati, reported two cases to the 
Cincinnati Medical Society, at the October meeting, 1879. 
They were two sisters, in whom menstruation had been en- 
tirely absent, though they had attained to the nges of twenty 
and twenty-two years respectively. This absence of menstru- 
ation and a failure to effect its establishment by remedies, led 
to a physical examination, which revealed the vagina in each, 
short and small, the clitoris large and long, resembling greatly 
the penis. No uterus could be found in either. The parents 
of these persons were first cousins, and both died of phthisis. 

A. S. Taylor, in his work on Medical Jurisprudence, reports 
a case of Prof. Mayer's, of Bonn, which is the nearest approach 
to a true hermaphrodite which I can find on record. The 
autopsy revealed on the right side a withered testicle with 
a prostate gland and penis; while on the left there was the 
uterus, ovary, Fallopian tube, and vagina. 

Around these cases clusters considerable interest, not 
only on account of their abnormal development, but on account 
of their legal rights as individuals, — whether they may vote 
or not, as being a ground for divorce, and regarding the 
paternity and maternity of offspring claimed to have been 
born of such people. 

Hypertrophy of the labia minora, or nymphce, is more com- 
mon. It may also occur as a congenital or acquired deform- 
ity. Sometimes only one side is enlarged, and sometimes 
bothT*~ I have thought that these women were more than 
ordinarily passionate, and their own testimony corroborates 
the correctness of the statement. The labia minora extend, 



Plate XXX. 




HYPERTROPHY OF THE LABIA MINORA. 



HYPERTROPHY OF THE LABIA. 725 

in many of these cases, much beyond the labia majora (see 
Plate XXX), and as they are very elastic they may be drawn 
down six inches or more. These cases are much more fre- 
quent than enlargement of the clitoris. They seem ordinarily 
to consist of a pure hypertrophy of tissue. Though perhaps 
not thicker than normal, they are enormously enlarged in cir- 
cumference. Their friction against each other in walking seems 
to excite sexual passion, and give rise in some cases to nymph- 
omania. Normally in young girls the labia minora are larger 
proportionately to the labia majora than in womanhood; but 
this condition in the young girl is not to be considered a dis- 
eased or deformed condition, as they shrink when the girl be- 
comes older, and the labia majora becomes more developed. 
Hypertrophy of the labia majora is said to be more com- 
mon in the East — i. e., Eastern Hemisphere — than with us. 
Here it is seldom met with, except as the result of the 
development of tumors in the parts (which may be solid or 
cystic). These solid tumors may be fibrous or fatty. Usu- 
ally but one side is affected in the same person. 

Diagnosis. 

The diagnosis of either of these conditions is to be made 
by physical examination. There is no opportunity to be 
mistaken in regard to their nature. The question of greatest 
interest is regarding their treatment. 

Treatment 

The enlargement of the clitoris usually demands no treat- 
ment. It has been amputated, but the operation is not rec- 
ommended. 

The enlargement of the nymphae is sometimes such a, 
source of irritation and annoyance as to demand removal. 
This is easily and safely accomplished with scissors, after 
placing the patient under the influence of an anaesthetic. 
(See Fig. 69.) The hemorrhage is usually not severe, and 



726 EATON ON DISEASES OF WOMEN. 

may be arrested by applications of cold cloths. If a blood- 
vessel is cut of any size, it may be twisted with forceps, 
or ligated. The Ferri persulph. should, however, be at hand 
in case of troublesome oozing of blood. The entire nymphse 




Fig. No. 69. — Emmet's Curved Scissors. 

need not be removed, as the excision of the excess of devel- 
opment is all which is required. 

In hypertrophy of the labia majora nothing need be done 
unless the enlargement is so excessive as to obstruct the 
limbs in walking, in which case the enlargement is usually 
due to the growth of a tumor in its substance, or pudendal 
hematocele. This may be removed by incising the mucous 
membrane, and enucleating the tumor, if possible. This can 
readily be accomplished in case the tumor is fibrous, hard, 
encysted, or fatty; but when cystic it is sometimes impossi- 
ble, in which case we may evacuate the cyst, and attempt 
to peel off the cystic wall with the fingers, or the handle of 
the scalpel, being careful about incising the deep tissues of 
the labia. If we can not detach the cyst wall we may mop 
it out with Tr. of Iodine, and apply compression. 

After the removal of the tumor in the labia the enlarge- 
ment shortly disappears by absorption. Small, hard, or en- 
cysted tumors, or thrombi in the labia, mny exist for many 
years without causing any inconvenience, and, hence, require 
no treatment. 

Thrombi in the labia, or pudendal hematocele, may cause 
an abscess, in which case it is to be evacuated, and treated 
as directed under the head of "Abscess of the Labia." 



Plate XXXI. 




HYPERTROPHY OF THE LABIA MAJORA. 



EXTIRPATION OF THE UTERUS. 727 



CHAPTER LXVI. 

EXTIRPATION OF THE UTERUS— ABLATION OF THE UTERUS, 
HYSTEROTOMY, ETC. 

Extirpation of the uterus has been, and is still, consid- 
ered one of the most formidable operations in surgery. 

There is little experience to guide our opinion of its 
advisability. Pean, of Paris,* gives the results of forty-four 
cases, by different operators, of partial or complete ablation 
of the uterus, by gastrotoiny. Fourteen recovered, and 
thirty died. Dr. Pean does not appear to mean that the 
entire uterus was extirpated, but that the supra-vaginal por- 
tion was, as he says:f "Amputation of the supra-vaginal 
portion of the uterus is not an operation of much graver 
character than extirpation of ovarian cysts complicated by 
adhesions." 

The operation cau not be advisable in cases of cancer, as 
the entire system is so much affected as to make the appear- 
ance of the disease in other parts only a question of time. 
Large intra-mural uterine fibroids (either subserous or sub- 
mucous) give rise to the advisability of the operation for the 
extirpation of the uterus by means of gastrotomy. 

T. Wood, M. D., of Cincinnati, stands to day the most 
successful operator in extirpation of the uterus (so far as I 
can learn) who has ever lived. He reports eight cases of 
extirpation of the uterus, with but three deaths. His report 
was published in the Cincinnati Lancet and Clinic, and repub- 
lished in the Obstetric Gazette, March, 1879. I take pleasure 
in making a quotation of his report, and presenting cuts of 

* "Hysterotomie," by J. Pean and L. TJrdy, Paris, 1873. 
t Thomas's ''Diseases of Women," p. 519. 



728 EATON ON DISEASES OE WOMEN. 

the tumor and uterus removed from case No. 8 (for which 
I am under obligation to the publishers of the Lancet and 
Clinic). 

"I wish to distinctly impress on your mind the fact, 
that in every operation given in this report, the body of the 
uterus was removed — amputated through the neck as close 
to the vaginal connection as possible without opening the 
vaginal cavity. The removal of fibroids is secondary, and 
not the prime object to which I wish to claim your atten- 
tion. I make this report to give evidence that it may he 
construed by the profession as favorable or unfavorable to 
hysterotomy. The question whether a woman can bear 
without a fatal result the complete ablation of her uterus 
and thereafter enjoy life and health, is the one that an en- 
lightened profession now desires to have answered either in 
the affirmative or negative. Then if in the affirmative every 
individual operator desires to have light from the experience 
of others — to determine whether any special case that may 
come under his care can possibly survive so formidable a 
procedure. 

" Tables of statistics are valuable guides to the formation 
of a correct judgment, but at the present time, though there 
are several extant, they are too loosely put together or in- 
efficient to establish clearly the legitimacy of the operation. 
So we find that wherever the operation is presented to any 
of our learned bodies for discussion a great diversity of 
opinion is expressed, and the preponderance is adverse to its 
performance. 

"If we examine the tables of Dr. Samuel Pozzi, of Paris, 
published in 1875, we find tabulated all of the reported opera- 
tions up to that time ; but if we examine closely the cases 
here tabulated, we discover that the largest number were 
only gastrotomy with partial operations on the uterus, and 
in many that organ was not touched by the knife, as when 
pedunculated, sub-peritoneal, or fibro-cystic tumors were 



EXTIRPATION OF THE UTERUS. 729 

removed, and should not be set clown either for or against 
hysterotomy. 

"Of the 119 cases tabulated by Dr. Pozzi the smallest 
number were complete operations, the balance were partial as 
applied to the uterine body. Further analysis shows that 
the partial operations were more fatal than the complete. 

"This view of Dr. Pozzi's tables confirms the opinion 
that has long since been forced on me by sad experience, 
that partial operations on the uterus when reached by gas- 
trotomy are more fatal than its entire ablation. I could 
give many cases that have occurred in my own practice that 
fully sustain this opinion. If an ovarian tumor or cyst im- 
pinges on the uterus and becomes closely adherent to it so as 
to require a dissection to separate them, it will very much 
enhance the danger of the operation, and will most likely 
prove fatal. 

"I might speculate much in explanation of this fact, but 
will dismiss the subject with the remark that the uterus is 
much more tolerant of violence done to the interior mucous 
surface than to injury through that of the peritoneal. 

"Case First. — Mary W , widow; was admitted to 

the Commercial Hospital, Oct. 1st, 1866. Her abdomen was 
enlarged to about the size of a six months' pregnancy. En- 
largement hard and smooth, occupying the medium posi- 
tion — is only slightly movable. She has a constant leucor- 
rhoeal discharge from the vagina — frequent attacks of pain in 
the abdomen — painful micturition — and great difficulty in 
forcing a passage from the bowels. The tumor was first 
noticed by her about three years before her admission to the 
house. 

"The diagnosis was, fibrous tumor of the uterus, and its 
removal by abdominal section was decided on. On the 31st 
of October I operated in the presence of a large class of 
students and medical gentlemen of the city. The early 
steps of the operation were the same as in ovariotomy. 



730 EA TON ON DISEASES OF WOMEN. 

and are so familiar to you all that I need not repeat them 
here. 

"The patient was, of course, anaesthetized, chloroform 
being the agent used. The uterus containing the tumor was 
raised from its position and supported by assistants — while 
ligatures were applied to the ovarian vessels on each side, 
and lateral attachments were dissected from the uterus down 
to its connection with the vagina. Here a needle was passed 
through the neck of the uterus armed with a strong, double 
silk ligature. The ligatures being tied, the neck was cut off 
and the tumor removed. The ends of the ligatures were 
brought out together at the lower end of the abdominal 
wound, and the subsequent dressing was the same as in 
ovariotomy. 

"The loss of blood was very small, and the prostration 
of the patient was not greater than in ovariotomy. The 
ligatures separated, and were taken away on the twentieth 
day after the operation. The suppuration ceased, and the 
wound was closed in about thirty days after the operation, 
and the patient was up and about the house. She soon after 
getting up began to show symptoms of phthisis, and in about 
three months died of tubercles in the lungs. 

" Case Second. — Mrs. B , of Newport, Ky., presented 

herself with two well defined tumors occupying the left and 
right iliac regions, extending as high as the umbilicus, and 
one developing in the pelvis occupying the fossa of Douglas, 
and pressing severely on the rectum, bladder and vagina, 
and forcing the os uteri above the pubis so far that a sound 
could not be made to enter it. She suffered much from re- 
tention of urine and feces. On the 17th of June, 1872, I 
operated in the same manner as in case first, but found much 
difficulty in dislodging from the pelvis the lower tumor, 
merely from its size and impaction, but there were no peri- 
tonseal adhesions. 

" The arteries and pedicle were secured as in the first 



EXTIRPATION OF THE UTERUS. 731 

case, and the same dressings applied. The progress of re- 
covery was very favorable up to the twenty-seventh day. 
She had been up and walking about the room, (though the 
main ligature had not parted) when she was suddenly taken 
with severe abdominal pain, soon sank in collapse, and died 
the same day. A post-mortem revealed foecal matter diffused 
between the convolutions of the bowels. A small opening 
was found in the ilium, where it had rested near the uterine 
stump; from this the contents escaped. I had used very 
strong, thick, hard-twisted ligature for the pedicle, and it had 
irritated the point of the bowels that pressed against it, 
ulcerating through the coats. Since then I have used none 
but the softest, slack twisted silk. 

"Case Third. — Mrs. C , of this city had a trilobed 

tumor, almost precisely the same size and form of the one 
taken from Mrs. Burns. I operated on the 29th of October, 
1872. She recovered perfectly and is now living. 

" Case Fourth. — Mrs. C , of St. Louis, had a single 

fibroid of the uterus, that, when removed, weighed 51 
pounds. 

" She suffered with paroxysms of severe pain in the ab- 
domen, and cerebral and nervous disturbance. She would 
often fall as with epilepsy, and sometimes remain for two or 
three days completely unconscious. I operated on her on 
the 14th of April, 1874. The uterine sinuses and ovarian 
veins were much enlarged and distended with very dark, 
venous blood, and a large quantity of blood was lost in 
operating. 

" Since the removal of the disease the peculiar nervous 
disturbance has entirely disappeared, and she enjoys com- 
paratively good health. She is still living, and visited this 
city a few weeks since. 

"Case Sixth. — Mrs. B , of St. Louis. In this case 

there was a fibroid within the uterus that carried it some 
distance above the umbilicus. The tumor had existed about 



732 EATON ON DISEASES OF WOMEN. 

four years, and her general health was much broken. Loss 
of appetite, vomiting after eating, and considerable emacia- 
tion; her complexion was bad, presenting a peculiar, waxy ex- 
sanguinous appearance. I operated on the 6th October, 1874. 
The operation was performed on Tuesday, and she died on 
the Friday following of peritonitis. I had to remove an ovary. 

"Case Sixth. — Mrs. F , of Jefferson County, Ohio. 

There were two large fibroids in this case — one developed 
in the pelvis and the other above the pubis, reaching as high 
as the umbilicus. 

a The bladder was attached to the upper tumor in front, 
and had to be dissected from it for a distance of five inches. 
The broad ligaments were thickened and drawn tightly across 
the uterus between the tumors with strong adhesions, re- 
quiring much dissection to free the lower tumor from its bed 
in the pelvis. The operation was made on the 24th of 
October, 1874. The patient recovered and is now living, 
enjoying, I believe, good health. 

" Case Seventh. — Mrs. S , of New Richmond, Ohio. 

This was a trilobed tumor, one in the pelvis and two above 
the pubis. One ovary had several small fibroids growing 
upon it and had to be removed, and the neck of the uterus 
was so much involved that I had to ligate the vagina, and 
had to remove the entire uterus. 

" The bladder was attached to the sulcus between the 
two upper tumors, and was twisted round so as to be behind 
them. The lower tumor was firmly adherent at many points, 
and had to be dissected loose, and several arteries in those 
adhesions had to be tied. 

"I operated on the 9th of November, and did not see the 
patient that day; but she reacted favorably, and seemed to 
promise a, good recovery until about Christmas, when a hem- 
orrhage from the vagina made its appearance, continuing until 
New Year's day, 1875, when she died, living fifty-three days 
after the operation. 



EXTIRPATION OF THE UTERUS. 733 

" Case Eighth. — Miss C, aged thirty-six years. Noticed 
an enlargement of the abdomen about twelve years since. 
Did not experience much inconvenience before the last two 
years. Now suffered very much at her menstrual periods, 
though she has always been regular and never troubled with 
profuse menstruation. Uses Morphia largely. The tumor is 




Fro. No. 70. — Extirpated Uterus. 

solid, smooth, and even on its surface. Slightly movable, 
and extends nearly to the ensiform cartilage. She is ema- 
ciated, and bears a haggard, distressed countenance. She 
was operated on on the 20th of February, 1878. 

ki The abdominal incision was extended about tw T o inches 
above the umbilicus before the tumor could be raised from its 
position. Both ovaries were involved in the disease, and 
were removed with the uterus. Her recovery was slow, be- 
ing retarded by the immoderate use of Morphia, which I 
could not. for a time, prevent. She eventually left off the 
Morphia, gained health and strength rapidly, and made a 
good recovery. She now lives in this city in full enjoyment 



734 



EA TON ON DISEASES OF WOMEN. 



of perfect health, walks all around the city, goes to picnics, 
and says she never felt better in her life. 

"The cuts exhibit two views of the tumor from Case 
8 th, one anterior and one posterior. 

"The termination of these eight cases, then, was as 
follows : 



Mrs. W- 
Mrs. B- 
Mrs. C- 

Mrs. C- 



-, recovered. 
, died. 

recovered. 

recovered. Miss C 

Recoveries, 5; deaths, 3. 



Mrs. B- 
Mrs. F- 
Mrs. S- 



died. 

recovered, 
died, 
recovered. 




Fig. No. 71. — Extirpated Uterus. 



"Dr. Gilman Kimball, of Lowell, Massachusetts, in his 
report on ' Extirpation of the Uterus ' (see ' Transactions of 
the American Medical Association,' Vol. XXVIII, page 330), 
in enumerating the dangers and objections to the opera- 
tion, says : 

"'Another difficulty oftentimes met with in this opera- 
tion is adhesions, more or less extensive. If these implicate 



EXTIRPATION OF THE UTERUS. 735 

the bladder, as they frequently do, they of course add im- 
mensely to the embarrassment as well as the dangers of 
the operation/ 

" Two of my cases had this very complication, requiring 
extensive dissection to separate the bladder from the tumor. 
One of them recovered, and the other survived the operation 
fifty-three days, and had no urinary inconvenience resulting 
from the dissection. Again, Dr. Kimball says (on the same 
page) : ' There is still another class of uterine fibroids where 
surgical interference would be still more objectionable than in 
the cases just referred to. I allude to instances where the dis- 
ease has developed in a downward direction and become fixed, 
as it were, in the lower portion of the pelvic cavity. . . 
In such a state of things extirpation would scarcely be 
thought of except by the most reckless operator.' 

"And yet four of my cases had just 'such a state of 
things,' and it was because 'that state of things' existed and 
rendered the lives of my patients an intolerable burden that 
I was called on for relief, and for which I operated. Two 
of the four recovered, and are now living; two died, one 
twenty-seven days and the other fifty-three days after the 
operation." 

We notice that in the one case where the vagina was 
ligated and the cervix was removed with the body of the 
uterus the patient died. 

Extirpation of the fundus uteri would appear a more 
appropriate term than extirpation of the uterus, or ablation 
of the uterus, as used by Professor Pean in such cases. 
Professors Wood and Pean have demonstrated the prac- 
ticability of removing the fundus uteri, together with a 
fibrous tumor of the walls of the uterus, Dr. Wood giving 
us a report of sixty-two and a half per cent of recoveries 
from the operation. 



736 EATON ON DISEASES OF WOMEN. 



CHAPTER LXVII. 

HYSTERAL GIA — NEURAL GIA UTERI— IRRITA BLE UTERUS — 
ASCITES IN WOMEN. 

The terms hysteralgia, neuralgia uteri, formerly termed 
irritable uterus, etc., indicate a neuralgic condition of the 
organ, which is sometimes very severe, although no organic 
disease of the parts can be discovered. It is to be diagnosed 
by the severe pain of a neuralgic character in the uterus, and 
the occurrence in some other parts of the body of neuralgic 
pain, and from the fact that physical examination reveals no 
lesion or displacement of the uterus. 

It is notable that of late years irritable uterus, hyster- 
algia, etc., are seldom mentioned, while formerly they were 
diagnosed almost as frequently as some physicians now diag- 
nose liver complaint (whenever the disease seems obscure). 
This is possibly due to the fact that uterine diseases of late 
years have been better understood than they were formerly. 
It may have been the case that diseases of the uterus, which 
are now readily diagnosed and treated, were formerly de- 
nominated irritable uterus, or hysteralgia, from the fact of 
pain being suffered in the part, and from the fact that, the 
physician being unable to discover any abnormal condition 
of the substance or position of the uterus, no other name 
seemed appropriate. The uterus is liable to be affected with 
neuralgia as well as the stomach or other parts of the body, 
and, consequently, the physician should recognize the disease 
when present, and treat it properly, though we know from 
experience that it is not a very common affection. 

Neuralgic dysmenorrhoea is of occasional occurrence, but 
is not one-tenth as frequent as is generally supposed. 



HYSTERALGIA. 737 

Neuralgic dysmenorrhea we do not discuss as hysteralgia, 
purely for the reason that its consideration comes as well 
under the head of dysmenorrhcea. It is, however, strictly 
one form of hysteralgia. 

Etiology. 

The causes of hysteralgia, or neuralgia of the uterus, are, 
first, cold affecting especially the nerves of the system, and 
manifesting the most severe symptoms at the point of irrita- 
tion, or in a part connected with the affected portion through 
the ganglionic nervous system; atmospheric influences, severe 
mental excitement, imperfect digestion, torpidity of the nor- 
mal secretions, etc., etc. 

Symptoms and Diagnosis. 

Pain in the uterus is the important symptom. The pain 
is of a darting, cutting character, and is changeable, affecting, 
perhaps, the uterus one hour, and the face, back, or thigh 
the next. Changing from place to place is, perhaps, the 
particular characteristic of the pain. Sometimes it is period- 
ical, occurring at the same hour each day, like an ague, or 
twice in twenty-four hours in some cases. The paroxysms 
are severe, but when they subside they leave the patient 
feeling comfortable and easy. Dysmenorrhceal pains are 
intermittent, but the intervals are short, often not more than 
five minutes. Examination of the uterus shows the organ 
to be in proper position; and when examined between the 
attacks of pain the examination gives no discomfort. There 
is a small class of cases where the uterus is supersensitive 
to the touch, although the sensation is a titillation, and not 
a pain, where excessive sexual passion is present, and wdiere 
the term irritable uterus seems appropriate. In these latter 
cases barrenness is the rule; and when conception does occur 
the uterus soon contracts, and expels its contents, owing to 
its excessive irritability. I refer now to cases where there 



738 EATON ON DISEASES OF WOMEN. 

is no leucorrhoea, and where previous to the occurrence of 
pregnancy the uterine sound had been introduced, without 
causing any pain, in order to discover if stenosis was the 
cause of the barrenness. 

As we become more familiar with the diseases and con- 
ditions of the uterine organs we may discover that all of 
these painful or supersensitive conditions have a cause aside 
from nerve irritation. But at presant we imagine that the 
nerve tissue itself is alone affected in some cases of pain in 
the uterus, giving rise to the propriety of using the terms 
hysteralgia, neuralgia of the uterus, and irritable uterus. 

In diagnosis it is necessary that we do so by exclusion 
in part — i. e., by determining that this or that disease is not 
present, which might cause pain if it existed. These patients 
are usually fretful, moody, irritable, and disagreeable gener- 
ally. They frequently manifest hysterical symptoms, mag- 
nify every thing they speak about, whether good or bad. 
They are active, but soon tire; are exceedingly lively at 
times, and again as dispirited as possible. 

Treatment. 

This complaint has baffled the best endeavors of many 
skillful men, and must in some cases continue to be an an- 
noyance, because we can not always use all the treatment 
we judge advisable, on account of the nervousness of the 
patient. As to remedies, they are usually among the follow- 
ing: Ars. alb., China, Hyosc., Aeon., Nux, Ignatia, Camph., 
Kali brom., Bell., etc. 

The diet should be strictly low and plain; stimulants are 
to be avoided. Placing the patient under the influence of 
an anaesthetic, and dilating the cervical canal with a dilator 
partially, and then inserting a sponge tent for a few hours, 
is sometimes a prompt cure. This overcomes the supersensi- 
tive condition of the uterus, the same as dilatation of the vag- 
ina relieves vaginismus. 



i 



ascites in women. 739 

Neuromata of the Vulva. 

Neuromata of the vulva signifies the existence of small, 
sensitive .points around the margin of the vaginal orifice. 
They are of two kinds : The first, and most common, consisting 
of the remains of the hymen, and the other, true neuromata. 

Treatment. 

Complete extirpation is the treatment. Seize the sensi- 
tive point with the forceps, and lifting it up snip it off at 
once with scissors ; apply styptics if necessary, and anoint 
with Vaseline till healed. 

Ascites in Women, Tapping, Abdominal Dropsy, etc. 

Tapping the peritoneal cavity in cases of ascites in women 
is somewhat different from the same operation in men. There 
is also more difficulty in diagnosing ascites in the female 
than the male, owing to the uterine and ovarian diseases and 
enlargements which may simulate it. 

Etiology and Pathology. 

The causes of abdominal dropsy or ascites in the female 
are similar to those in the male, with the additional irritation 
liable to be communicated to the peritonaeum from uterine 
disease, especially inflammation. 

Ascites must be preceded by some amount of peritonaea! 
inflammation. It may be of so mild a character as to escape 
observation by the careless or very busy practitioner, and the 
pain experienced from it may not be very severe, and still 
dropsy of the abdomen may result. Abdominal dropsy or 
ascites consists of an effusion of serous fluid into the peri- 
toneal cavity. The fluid effused is essentially serum, variously 
changed, owing to the peculiar conditions of the patient. 

Peritonitis may exist primarily in the female as well as 
in the male, or be a result of extension of inflammation from 



740 EA TON ON DISEASES OF WOMEN. 

the bowels or other abdominal organs. Accompanying this 
irritation there usually is a torpid condition of the glandular 
system, especially the liver and kidneys, and very frequently 
there is a want of normal action in the skin, causing an arrest 
of both sensible and insensible perspiration. This causes an 
excess of serum in the blood, and it is consequently the 
more readily effused into the serous cavities. 

Diagnosis. 

In ascites the lower part of the abdomen is first noticed 
to be enlarged. This is most observable when the patient is 
in an erect position, either sitting or standing. While reclin- 
ing the enlargement apparently disappears as the fluid gravi- 
tates upwards while the patient reclines, and downwards so 
as to distend the lower abdomen when erect. As the dis- 
ease progresses the entire abdomen becomes so much dis- 
tended as to be observable when the patient reclines. Per- 
cussion with the extended palm communicates a sense of 
fluctuation to the other hand placed upon the opposite side 
of the abdomen. Place the patient on her side, and the 
most dependent portion of the abdomen is found to be dull 
on percussion, while there is resonance in the upper portion. 
This is due to the intestines floating to the top, as they 
usually contain a small amount of gas, which renders them 
lighter than the effusion with which they are surrounded. 
This is an important point to recollect in diagnosis. 

Differential Diagnosis. 

The diseases and conditions liable to be mistaken for 
ascites are ovarian cystoma, cyst of the broad ligament, 
uterine fibroma, fibro-cystic tumors of the ovary, intra-mural 
fibroids of the uterus, and pregnancy (especially extra-uterine 
pregnancy). 

The student is referred to these subjects for a more com- 
plete description of the points which differentiate ascites from 



ASCITES JN WOMEN. 741 

these ailments and conditions ; but we will briefly note a few 
here, in order to save time in reading the rather extended dis- 
cussion of some of these diseases, which we have made in other 
places in this work. It would not be a pleasant experience 
to mistake either of these conditions for ascites, and proceed 
to tap for its relief; hence a careful diagnosis is desirable. 

Ovarian cystoma, fibro-cysts of the ovary, and cysts of 
the broad ligament, develop from the iliac regions, and not 
from the entire lower abdominal regions, where ascites is 
first observed. In these diseases the enlargement is felt 
when the patient reclines, circumscribed in extent, somewhat 
fluctuating, but not freely so. 

In the advanced stages of these diseases they more per- 
fectly simulate ascites than in their smaller development. 
Here the resonance upon percussion over the superior portion 
of the abdomen, while the patient is reclining, with dullness 
on the sides, indicates ascites, while in the case of the cystic 
tumors the intestines are usually crowded to one side, and 
there is dullness over the superior part of the abdomen. In 
ascites the resonance is found in one place at one time, and 
in another at perhaps the next examination, while in these 
tumors the resonant portion is found at about the same place 
at each examination. 

The history of the development of the abdominal enlarge- 
ment is also an aid in the diagnosis. In normal pregnancy 
there should be an arrest of menstruation, and the enlarge- 
ment is felt as a circumscribed tumor in the hypogastric 
region. In the later months of abdominal pregnancy the 
pulsations of the foetal heart settle the diagnosis, though 
pregnancy may be complicated with ascites in some cases. 

In extra-uterine pregnancy the tumor is felt circumscribed, 
and can be felt more distinctly when the patient is reclining 
upon the back, while in dropsy in its earlier stages the 
enlargement disappears when reclining. In the later months 
of extra-uterine, or abdominal, pregnancy the foetal heart's 



742 EATON ON DISEASES OF WOMEN. 

throbs again help us in making the correct diagnosis. Uter- 
ine fibroma, fibroids of the ovary, and enlargement of the 
uterus from the development of intra-mural fibrous tumors, 
are hard to the feel, compared to ascites; and as they have 
no fluctuation they should readily be differentiated from 
ascites. 

Treatment. 

We do not deem it within the scope of this department 
to enter into the general treatment of dropsy. I will barely 
say that among the remedies I have found useful are Ars. alb., 
Ars. iodid., Dig., China, Merc, cor., Merc, iod., Kali iod., 
Sang., Sidph., etc. Remedies should be our main reliance, 
administered according to their most prominent homoeopathic 
indications, or key-note symptoms, if you please. 

As there are occasionally cases which baffle the physi- 
cian's best endeavors at a cure, palliatives are sometimes de- 
manded. I do not mean opiates or anodynes ; but I mean 
that the friends of the patient, the patient herself, as well 
as our sympathy for suffering humanity, require we should 
do something to prolong life, and make it as comfortable as 
possible while it lasts. For this purpose tapping is expedient 
and proper. We do not think it wise to recommend or use 
it, as has been before intimated, till remedies have failed us, 
and not then, until the patient suffers great inconvenience 
from the excessive accumulation of fluid, manifested by diffi- 
culty of motion and respiration, inability to lie down and 
rest, derangement of digestion, etc., etc. 

Operation. — The instrument necessary for this operation 
is a short trocar. The patient may sit in an easy chair, 
slightly tipped backwards. The abdomen is now fully ex- 
posed, and a piece of sheet, about two feet wide and the full 
length of the sheet, should be passed around the body, after 
being torn down at each end into three strips within about 
eighteen inches of the center on each side. These should be 
interlocked, and held by an assistant on either side. 



TAPPING. 743 

We now make a puncture into the abdominal cavity with 
the trocar, about midway between the pubis and umbilicus, 
in the median line. After Ave feel the instrument pass 
through the tissues we should at once withdraw the stylet, 
and then press the canula further in to avoid its slipping 
out. If we did not first withdraw the st}det we might 
wound the mesentery, or intestines. A large vessel, previ- 
ously procured, receives the discharge. We now direct the 
assistants to make traction upon the ends of the bandage 
to compress the abdomen, in order to force out the liquid, 
and also to prevent collapse. Previous to the insertion of 
the trocar it is best to manipulate the bowels to some extent, 
to cause the intestines to rise out of the way, and float on 
the surface of the fluid, so that they be not wounded. 

After the fluid is all drained off the canula is to be with- 
drawn, and a piece of adhesive plaster placed over the punc- 
ture. The bandage is now to be slightly relaxed, and pinned. 
If left too loose, faintness would be likely to ensue; if too 
tight, the remaining fluid might be forced out of the perito- 
neal cavity between the abdominal muscles. 

By making the puncture in the locality named there is 
ordinarily little clanger of wounding any blood-vessel. The 
puncture should not be made very much to one side of the 
median line, for fear of wounding the epigastric artery. If 
we wound an artery internally, by mistake, the patient will 
not long survive. If an artery (epigastric) is wounded ex- 
ternally we may try compression by plugging the puncture. 
If this does not suffice we must incise the puncture suffi- 
ciently to expose the artery, and ligate it. 



'44 EA TON ON DISEASES OF WOMEN. 



CHAPTER LXVIII. 

BA THING — VA GINAL WASHES— STOMA TIT IS MA TERN A. 

Water is like fire — very good in moderate amount, but 
capable of harm when used to excess. Fire may burn your 
house, though it is very good in the furnace in moderate 
amount. Water may drown us, or save our lives. 

Bathing is a necessity for health; still, it is possible to 
bathe too much, and at improper times ; and while we may 
well recommend bathing we have often to caution ladies 
against bathing too frequently. Much depends upon the 
temperature of the bath and the health of the person. One 
patient may require frequent bathing for a time, and still it 
might prove injurious if continued too long. There being 
such a diversity of opinion regarding bathing and the use 
of the vaginal syringe, we think it prudent to say a word to 
the student upon these subjects, not only as remedial, but 
as hygienic, agents. 

Bathing should be used for purposes of cleanliness, and 
to keep open the pores of the skin, and allow of the free 
escape of the insensible perspiration constantly going off from 
the healthy body. For this purpose the water used in bath- 
ing should be of a temperature usually termed tepid or warm, 
ranging from 60° to 70°. The use of pure soap, a little am- 
monia or soda in the water is not objectionable, if only used 
occasionally. 

Once a week in cool weather, and once a day in very 
warm weather, a bath may be allowed the healthy person ; 
but she should not, as a rule, remain in the bath more than 
ten minutes. Remaining in the bath an hour or more, as is 
the practice of some, debilitates the system, and can not be 
well endured except by those adipose individuals who seem 



BATHING. 745 

to be benefited by a sort of stew. The lean, nervous person 
will be injured by it. 

On rising from the bath the entire surface of the body 
should be briskly rubbed with a dry, coarse towel. When 
the temperature of the bath-room is up to 68° or 70° the cold 
shower bath may be taken for a moment when first rising 
from the tepid or warm bath, which should be followed by 
brisk rubbing, as before mentioned. After drying the body 
thoroughly warm clothing should be put on, and some brisk 
exercise at once taken, to keep the blood in active circula- 
tion. Sitting or riding in cool atmosphere must be avoided 
after a bath. 

Time for Bathing. — The bath may be taken before eating, 
on first rising in the morning most advantageously, if active 
exercise can very soon be taken. A patient should not bathe 
just after a full dinner. It is unsafe to take a warm bath 
before retiring (the very time many choose). There is much 
greater danger of taking cold after a bath at this time than 
when bathing in the morning, and at once engaging in active 
exercise. 

The Sponge Bath. — Sponging the body does not require as 
much precaution as the full bath. Active exercise after it is 
advisable, however. The cool sponge bath is most desirable, 
except in those very feeble patients who would feel chilled 
by it. This bath must be followed by brisk rubbing until a 
full glow of the skin is secured. 

Medicated baths may at times be of use, as this is but 
another way of taking medicine into the system. They 
should only be used of a kind suited to the needs of the 
patient, and are on no account to be used indiscriminately. 
In electrical baths, so called, I have little or no confidence. 

The Hip and Foot Bath. — The warm hip and foot bath 
is sometimes of great service in attracting the circulation to 
the parts, and is useful in cases of amenorrhoea, especially 
when caused from sudden cold. 



746 ea ton on diseases of women. 

Vaginal Washes. 

As a rule we do not recommend vaginal washes. Many 
times, when the full bath, or the hip bath, can not conve- 
niently be taken, the use of the vaginal injection of warm 
water is desirable for cleanliness of the parts; and they are 
sometimes useful in allaying irritation of the mucous mem- 
brane of the vagina, and exert a good effect upon the inte- 
rior uterine surface through continuity of surface. In using 
the vaginal syringe the central opening in the tube should 
be soldered up tightly to prevent the accidental introduction 
of the water into the uterine cavity. The tube should not 
be introduced against the os uteri in any case. The fountain 
syringe of Davidson, or one similar, is most desirable, because 
it is simple, cheap, and efficient. The quantity of water used 
should be large, so as to keep the stream running evenly for 
some time, the patient sitting the while over the chamber, 
and pumping the water in a steady stream. 

Complicated instruments, for giving vaginal injections will 
be found more beautiful in theory than useful in practice. 

Cold vaginal injections are not only detrimental, they are 
dangerous. This should be told patients with decided em- 
phasis. They are a fruitful source of uterine disease. Espe- 
cially should they never be used immediately after copu- 
lation (as is done by some to prevent conception). The 
parts are then in a condition of congestion, and the applica- 
tion of sudden cold is likely to produce inflammation, and 
produce a nervous shock to the whole system. Cold water 
thrown by accident into the. uterus, in such a case, may pro- 
duce death in a short time ; and should death not ensue, the 
uterine colic induced is sufficiently severe to cause the 
stoutest nerves to quail. The depression following is equally 
alarming, coldness of hands and feet, the feeble pulse, the 
blanched, cadaverous countenance, are sufficient, when once 
seen, to produce an impression for life upon the beholder. 



STOMA TITIS MA TERN A. 747 

But I only wish to say enough to put the student on his 
guard and cause him to warn his patients in time. 

Stomatitis Materna, or Nursing Sore Mouth. 

Stomatitis materna is a disease peculiar to women who are 
nursing or pregnant, but sometimes continues after the mother 
ceases to nurse her child. Its pathology and etiology are not 
well understood. It is a distressing complaint, and right- 
fully comes under the notice of the physician who makes the 
diseases of women a special study, though very generally 
ignored by writers upon these diseases. 

Etiology. 

The cause of stomatitis materna is mainly due, we believe, 
to the irritation of the stomach from the enlargement or irri- 
tation of the uterus, thereby causing irritation of the sym- 
pathetic nerves ; or producing irritation in the stomach 
through the irritation of the breasts from nursing in women 
of scrofulous constitution and nervous organization. 

Why uterine disease does not, ordinarily, produce this 
condition of the mouth we are unable fully to explain. The 
abstraction from the system of the mother of nutrition, 
either while the child is in utero or at the breast, seems the 
most plausible explanation of the development of the disease. 
It is usually not present in other cases of irritation of the 
uterus, even where the uterine irritation is apparently much 
greater than during gestation and lactation ; but this cause 
may keep up the disease. Imperfect digestion and assimila- 
tion of food seem to be connected with these cases, rendering 
the secretions irritating throughout the entire system. 

Symptoms anil Diagnosis. 

Soreness of the mouth is the main diagnostic symptom. 
This soreness is found to be connected with inflammation of 
the mucous membrane of the mouth. The inflammation varies 



, 



748 EA TON ON DISEASES OF WOMEN. 

in grade from slight redness to fully developed ulcerative 
inflammation. It may affect only a small portion of the 
membrane of the lips or tongue, or it may affect the entire 
membrane of the mouth and tongue, and even extend to the 
nasal passages and down into the bronchial tubes. 

There is usually present more or less gastric disturbance 
in the way of heat, burning, etc., or gastralgia after eating. 
Heartburn and sour eructations frequently occur. Emacia- 
tion is an almost constant symptom, especially in severe cases. 

If left to itself ulcerative action sometimes goes on to an 
alarming extent, destroying a large part of the tongue, lips, 
etc., and causing death through the want of digestion and 
assimilation, really amounting to starvation; as well as 
through the ulcerative action, which sometimes affects the 
stomach and intestines as well as the mouth. 

Stomatitis materna seems in a measure hereditary, owing, 
we presume, to inherited constitutional scrofulous taint and 
nervous weakness. When a lady once has the disease she 
appears more liable to have another attack in subsequent 
pregnancies or lactations ; in fact, under allopathic treatment, 
the disease often reaches over and continues from' one preg- 
nancy to another. (See Byford's Diseases of Women.) 

Treatment. 

In the first place, let the child be weaned if there is a 
severe and extensive inflammation. If the case is mild, 
remedies may be tried for a short time, and allow the child 
still to nurse ; but should the remedies fail while the child 
still nurses, it must be weaned and remedies continued. 
When the attack come on during gestation palliatives must 
be used as well as possible, together with indicated remedies 
till delivery is accomplished, when the lacteal secretion 
should be suppressed by the use of Bell., Caniph., etc., applied 
locally to the breasts, and let remedies for the cure of the 
stomatitis be continued. 



STOMATITIS MATERNA. 749 

Among remedies for this disease I will mention Ars., 
Merc, cor., Borax, Bry., China, Ferrum, Kali chlo., Phy- 
tolac. dec, etc. Arsenicum emphatically takes the lead, as 
it is indicated in about every case, and is often the only 
remedy required. In some cases Ars. may be followed with 
advantage by some one of the remedies mentioned, when 
used according to the totality of the symptoms. In cases 
which are pregnant, a valuable palliative remedy is Borax 
and Honey, held in the mouth and then ejected. Sometimes 
Pulv. Charcoal is found palliative to the burning in the mouth 
and stomach in this class of cases. 



750 EATON ON DISEASES OF WOMEN. 



CHAPTER LXIX. 

NYMPHOMANIA ( THE "FUREUR UTERINE "OF THE FRENCH) —A TROPHY 
AND HYPER -IN VOLUTION OF THE UTERUS— ABSENCE OF 
THE UTERUS— MALFORMATION OF THE UTERUS— ANES- 
THETICS. 

Nymphomania consists in an uncontrollable desire in women 
for sexual congress. The passion becomes after a time insa- 
tiable and irresistible. At last mental alienation becomes 
complete, and no sense of modesty seems to be left. The 
patient will solicit, and attempt to consummate, the sexual 
act with any man who comes near her, without regard to 
those present. 

Etiology. 

The disease is supposed to be usually caused by mas- 
turbation. This is, doubtless, often the case ; but, we think, 
not always, as we have personally known of instances where 
the disease existed in its mildest form, i. e., where we would 
have been unaware of its existence but for the voluntary 
avowal of the patient (a condition not suspected by friends), 
where masturbation was denied by the patient. 

In these cases it seemed that a highly nervous organiza- 
tion with complete sexual development, and the excitation of 
the passions by the reading of exciting works of fiction, the 
stimulating effect of high living, and the caresses of lovers, 
had developed the condition, especially as marriage had not 
been consummated. In one case it seemed to be caused 
from the incomplete attempts at copulation on the part of a 
husband, many years her senior, who had become impotent. 
In another case, where the husband was young, but par- 
tially impotent. We have seen other cases, where the very 



NYMPHOMANIA. 751 

large development of the nymphse congenitally seemed to be 
the exciting cause. Enlargement and hypertrophy of the 
clitoris seems to have been the cause of this disease in some 
instances related to me ; but I have not seen an instance 
where this appeared to be the cause. 

Symptoms and Diagnosis. 

In the earlier stages of this disease the patient is shy of 
the presence of men, and would be considered rather diffident 
and modest in company ; but while alone with a male friend 
a striking change is perceptible. The eye kindles and stares, 
the countenance becomes flushed, and conversation upon im- 
modest subjects is invited by insinuation, or directly com- 
menced herself. The discussion of other subjects is dis- 
tasteful; marriage, love, lovers, beaux, etc., scandal and the 
like, seem to be her whole stock in conversation, though she 
may have been well educated. 

After a time her demeanor in company excites comment, 
and she openly speaks as she formerly would do only in 
private. Mentally she seems degenerated, memory is evi- 
dently impaired, and her attentions to gentlemen become too 
marked to come within the scope of propriety. 

Still later, the disease manifests the symptoms of com- 
plete abandonment, without modesty, shame or concealment, 
to the extent of making it impossible to allow her to come 
into the presence of men at all. In these sad cases, which 
may be found in almost any insane asylum or large "poor 
house," the mental faculties are about gone, a condition of 
dementia seems to be the true term to express her condition. 

Prognosis. 

When taken in its earlier stages and properly treated 
many cases recover. When fully developed the disease 
renders the case hopeless. 



752 EATON ON DISEASES OF WOMEN. 



Treatment. 

In the treatment of cases of this kind much tact and 
delicacy is required, as well as firm principles. The patient 
should at once engage in some manual labor to the full 
extent of her strength, and this must be continued. Canthar. 
30 x should be given, Camph. or Kali bro., Platinum y Picric ac, 
or Veratrum alb., given low, are also efficient remedies. Allow 
no beaux company to be received, recommend a cold bath 
daily. Let the patient's diet be very plain and non-stimulating. 
Let no novels be read, and the occupation of the mind should 
be secured by the reading of works upon geology, or by 
the study of mathematics. After a year of this treatment, 
entrance into society may be allowed, and if a suitable 
matrimonial alliance can be consummated, sanction it. 

Cauterization of the clitoris is a barbarous, and so far as 
I can learn, a useless, practice in these cases. Clitoridectomy 
or amputation of the clitoris has also been practiced, and 
been found unavailing, and is to-clay entirely abandoned. 

Atrophy of the Uterus, and Hyper-involution. 

The uterus may be smaller than normal from infancy, 
which is termed congenital atrophy, or it may become atro- 
phied after the delivery of a child, which is termed hyper- 
involution. 

The condition of atrophy of the organ after the cli- 
macteric period is passed is normal. The girl affected with 
congenital atrophy of the uterus or ovaries will show less 
of sexuality in other ways ; the breasts are found rudi- 
mentary, the hair upon the mons veneris is small in amount, 
resembling a girl of fourteen, when she has attained to 
twenty-five or thirty years of age. Sexual passion is feeble 
or entirely absent. There is usually an absence of men- 
struation; or, if present, it is scant and irregular. Mental 



ATROPHY OF THE UTERUS. 753 

disturbances frequently accompany this condition, especially 
a want of mental capacity is manifest. 

Mr. Walter Whitehead* relates a remarkable case of 
hyper-involution, after confinement, going on to the extent of 
causing entire absorption of the organ. She became quite 
indifferent to sexual intercourse, and no examination could 
detect any uterus remaining. 

Ktiology and Pathological Anatomy. 

One cause of the congenital atrophy of the uterus may 
be found in some instances in the near blood relation of 
father and mother. Other causes are the tuberculous or 
scrofulous diathesis, chlorosis, etc. ; but in some instances 
the cause is obscure, from the fact that the development of 
other parts of the body, and the health, appear good. In 
these cases the walls of the uterus and cervix are thin and 
flabby, appearing to indicate a want of normal amount of 
muscular fibre. Ossification of the arteries may cause 
atrophy of the uterus. 

Symptoms. 

Absent or scant and irregular menstruation; want of 
energy ; childish appearance generally, in cases where the dis- 
ease is congenital. 

Diagnosis. 

The diagnosis is to be made by means of conjoined manip- 
ulation, one finger of the left hand in the vagina pressing 
against the os uteri, and the right hand pressing down upon 
the fundus through the abdominal walls; or we may pass 
the uterine sound, when we will find that the flabby condi- 
tion of the organ present is in striking contrast to its normal 
stiff and firm feel; and we find that its length is much less 
than natural. 

*Brit. Med. Jour., Oct., 1872. 
48 



754 EATON ON DISEASES OF WOMEN. 



Treatment. 



The scrofulous or tuberculous patient should be given 
Ph/tolac. dec, Calc, Chi., Arsen., etc., according to their 
homoeopathic indications. The chlorotic case demands Merc. 
cor., Ars. wd. y Ferriim, Ignatia, etc., ordinarily. Electricity is 
one of the most useful agents, as I have proven in many in- 
stances. Let the positive pole be attached to the uterine 
electrode when introduced into the uterus, and apply the 
negative to the spine, using a very mild primary current for 
about ten minutes, once in three days. The cool hip bath 
is also a useful adjuvant. Use a liberal farinaceous diet, with 
free exercise in the open air. 

Absence of the Uterus — Malformations of the Uterus. 

Cases of the entire absence of the uterus in women are 
exceedingly rare. The organ occasionally exists in a rudi- 
mentary state, having no cavity, and being of very small 
size. Malformations of the uterus are not so uncommon, 
though sufficiently so as to be of considerable interest. A 
septum existing in the organ/ dividing it 
P into two about equal parts, is perhaps the 
most frequent malformation. It is a condi- 
tion frequently not recognized, as impreg- 
nation may take place on one side, and the 
gestation and delivery may go on normally; 
menstruation may go on from the opposite 
side; and this condition may account for 
those anomalous cases where, menstruation 

Fig. No. 72.— Double 

uterus. continues in spite of pregnancy. Concep- 

tion may take place on the opposite side from which gestation 
is already going on. (See Fig. No. 72.) 

The septum represented in the cut is not always' contin- 
uous down to the os; still, if only extending down to the 
internal part of the cervical canal, it makes a double uterus 





MALFORMATIONS OF THE UTERUS. 755 

(termed uterus Ulocularis) , just as much as if continued down 
to the external part of the canal. Sometimes there exists 
a double cervical canal and a single uterine cavity. (See 
Fig. No. 73, representing the case of Mrs. T., of Cincin- 
nati.) This lady has never been pregnant, and has been 
troubled with excessive uterine hemor- 
rhage, for which she consulted me. I 
found a number of mucous polypi situated 
in the cervix, and cured her of these tu- 
mors; some months after which, the pa- 
tient, desiring offspring, again consulted 
me regarding her sterility. In attempting 
to examine the uterine cavity thoroughly, 
I found the cervix apparently ended in a 
pouch. As she menstruated, I was sure 

r 7 Fig. No. 73. — Double 

there was some communication with the cervix uteri. 

interior of the body of the uterus by way of the cervical canal. 
I, therefore, persevered in my examination with the sound, 
after dilating the canal with sponge tents. I now discovered 
a septum in the cervical canal. By passing the sound into 
the smaller opening in the os I succeeded in directing it into 
the cavity of the uterus. I found, however, a constriction 
at the internal os. This I also dilated with a tent, 

If the sterility continues it will be advisable to divide the 
septum with scissors, that the semen may more readily gain 
access to the uterine cavity. This case suggests the possi- 
bility that a septum in the cervical canal may be a cause of 
sterility when the septum leaves one side of the canal to end 
in a pouch. This condition may make the introduction of 
the sound into the uterine cavity an apparent impossibility. 

• Anesthetics. 

Anaesthetics are a great boon to suffering humanity. 
They have taken from surgical operations more than half 
their terrors. Anaesthetics may be used locally to produce 



756 EA TON ON DISEASES OF WOMEN. 

insensibility of a part of the body, which is done by a spray 
usually, and is most useful to the surgeon in general prac- 
tice. In gynaecological examinations or operations, general 
anaesthesia is demanded. This is accomplished by inhala- 
tions, and we prefer pure Chloroform, or a mixture of one 
part of Sulph. Ether to two parts of pure Chloroform. 

The important points in the safe administration of anaes- 
thetics consist in securing a partial inhalation of atmospheric 
air at the same time, and in having our patient in the reclining 
posture, with the head about as low as the body. Accidents 
from the use of anaesthetics have been mostly in those cases 
where the patient has been allowed to sit or semi-recline. 

Anaesthetics should only be given by assistants of expe- 
rience and judgment. The operator should not have his 
mind distracted by the care of the patient in this respect. 
We should also always have at hand a bottle of Spts. Ammo- 
nia and Nit. Amyle to revive the patient in case respiration 
ceases, and there is danger of dissolution. I will not go into 
the history of anaesthetics, but will simply suggest some pre- 
cautions as to their use, and recommend' them when used with 
care and discretion. The question frequently arises, whether 
or not they may be used in cases of weak lungs or with 
those who have heart disease. On general principles, we 
say no; still some palpitation of the heart in women who 
have uterine disease, does not preclude their use, as this pal- 
pitation is usually the result of sympathetic nerve action. 

In cases where a severe operation is imperatively de- 
manded in a lady suffering with some weakness of the lungs 
or heart, anaesthetics may be used in moderation and with 
special care. In cases of confirmed phthisis or severe valvular 
lesions of the heart, both the giving of the anaesthetic and the 
operation may usually be dispensed with, as life must soon 
ebb away at best, and it is useless to place the patient's 
life in imminent peril from an operation under such cir- 
cumstances. 



HYSTERIA 757 



CHAPTER LXX. 

HYSTERIA. 

Hysteria is the term applied to the manifestation of a 
class of symptoms peculiar in themselves, but varied in char- 
acter. Hysteria is not a disease in itself, but may be mani- 
fested in connection with a variety of diseases, notably those 
of a uterine or ovarian character; and hence hysteria is pe- 
culiar to women, though men are liable to nervous symp- 
toms, in part simulating those called hysterical in the female. 
Conditions indicating a sort of trance in the male have been 
termed hysteria by some old authors, but they were evi- 
dently cases which were malingering, as it is called (that is. 
pretending to disease which was not present). Doubtless in 
some women, as well as in men, there is malingering, and 
they frequently may manifest symptoms which, taken in 
themselves would be alarming, but when taken in connection 
with the hysterical symptoms in the case, they sink into 
insignificance, 

Hysteria is most common in women during the time that 
ovulation is going on, though some manifestations have been 
noted in young girls and in old women. It is aggravated, 
if not most frequently induced, at the menstrual epoch. It 
may, however, be developed during the intervening period, 
or it may come on during the period of gestation or nursing. 

Hysteria has been considered by some simply a pretense 
to disease, a malingering, for the purpose of exciting sym- 
pathy and attention. Now, while some women may be guilty 
of malingering to deceive and obtain sympathy where they 
are suffering from no disease worse than laziness, it is a 
great cruel tv to accuse all women who show nervous, change- 



758 EATON ON DISEASES OF WOMEN. 

able, spasmodic symptoms (called hysterical) of being simply 
pretending. 

In many cases the suffering of these patients is intense 
from disease, and they are as unable to control these mani- 
festations as they would be the agonies of labor. But very 
few can do it. We therefore bespeak for this class of pa- 
tients sympathy and kindness, often mingled with firmness, 
it is true ; still let firmness be mingled with gentleness, at all 
times, with these patients. 

Etiology. 

The cause of hysterical manifestations lies primarily in 
the irritable and weak condition of the nervous system. This 
may be hereditary or acquired by mental or physical labor in 
undue amount, by dissipation, late hours, loss of sleep, stimu- 
lating diet (to the neglect of that which is substantial, plain, 
and nourishing). Disorders of menstruation, frequent child- 
bearing, mental shocks, etc., may also induce this irritable, 
weak condition of the nervous system; These causes may 
be termed predisposing. 

Direct causes are to be found in displacements of or inflam- 
mation in the uterus or ovaries ; dysmenorrhoea, excessive, or 
entire want of sexual congress ; indigestion, causing gastralgia 
or flatulency, constipation; worms, vaginitis, vaginismus, dys- 
pareunia, pruritus vulvae, etc. The enlargement of the uterus 
in gestation, irritation of this organ from sympathetic irrita- 
tion of the breasts in nursing, disagreeable home associations, 
sudden colds causing amenorrhcea, etc., may develop hysteria. 

I believe all these causes, and perhaps many more, tend 
to produce hysteria in those patients who have a high ner- 
vous organization, and who are debilitated, especially those 
poorly nourished and of weakly constitution. There is in 
some an appearance of plethora and vigorous health. In 
these cases there is a want of proper balance of nerve 
strength, owing to some of the enumerated direct causes. A 



HYSTERIA. 759 

highly excitable sexual organization predisposes to hysteria,- 
and it is seldom manifested in women sexually torpid. 

Diagnosis and Symptoms. 

The symptoms of hysteria are extremely various. In 
the first place we note a perverted judgment, and an ex- 
tremely vacillating mind. They decide this way now and 
very soon reverse their opinion, laugh immoderately at trifling 
things and cry at mere nothing, stop sobbing and laugh at 
their own foolishness, and in a few moments weep again. 
At these times they often complain of a choking sensation 
in the throat, the "Globus Hystericus" as it is called. They 
cry out they are choking, and laugh and cry again. This 
class of symptoms are most common in the more chronic 
cases. 

In recent cases pain in the abdomen is often complained 
of, especially where there is indigestion and flatulency, 
dysmenorrhoea, constipation, or pregnancy ; and pain in the 
pelvis in cases of displacement of the uterus, or inflamma- 
tion of the uterus or ovaries. The patient in these cases 
sometimes falls down unconscious, froths at the mouth, tears 
her hair or clothing, bites her tongue, etc.; every muscle is 
rigid in spasmodic contraction, ojyisfhotonos being common. 
The jaws are often spasmodically closed, as in tetanus. The 
patient rolls about irrespective of the injury she may do 
herself. Semi-consciousness returns and lasts a few moments, 
and again an active convulsion sets in. These convulsions 
may come on in those cases which ordinarily show the 
milder symptoms, or the manifestations may be uniformly 
violent. These symptoms are likely to cause grave appre- 
hensions in the minds of her friends, and the physician 
should be quick to detect their nature, in order to allay their 
fears. 

In those women hysterically inclined or predisposed, the 
occurrence of almost any disease, or an extraordinarv amount 



760 EATON ON DISEASES OF WOMEN. 

of fatigue, may develop such severe symptoms as to mislead 
the physician, unless he is aware of the patient's peculiarity 
in this regard. 

Hysterical women are prone to magnify every slight ail- 
ment which they have. They, perhaps, do suffer more than 
others, because of the acute sensitiveness of their nerves. 

Hysterical Rage or Mania. — Raving and paroxysms of 
anger followed by sorrow, remorse, weeping, and self-con- 
demnation, is a symptom in some cases. They may, how- 
ever, laugh in a few moments, and again go into a causeless 
rage. 

Treatment. 

In violent cases, the first thing to do is to see to it that 
the patient does herself or others no harm. Physical re- 
straint is often absolutely necessary. A thin piece of a 
large cork placed between the teeth and then binding the 
jaws firmly, serves to keep the patient from biting her 
tongue, and also will enable us to administer remedies, which 
otherwise we might be unable to do. See that the feet are 
warm, the head cool, etc. Select remedies according to the 
condition of the patient, as well as the symptoms present at 
the time. Oimicif. JRac, is an excellent remedy when we 
have the history of the patient, showing ovarian pain. Puis. 
when there is amenorrhoea from cold, with tenderness in 
iliac region. Aconite, Gelsem., or Arsen., may be indicated by 
the pulse and the temperature of the skin, etc. 

Ignatia is, perhaps, our best remedy, so far as the purely 
spasmodic symptoms are concerned. When there is any 
tendency to conjestion of the lungs, Verat.viride, G-elsem., or 
Bryonia, may be indicated. Hyosc. is indicated if there is a 
tendency to immodesty manifested. 

Nux and Colocynthis, in alternation, are indicated in flatu- 
lency, and especially when pain centres around the navel. 
When the flatus is evidently in the colon, an enema of warm 
water, followed in a few minutes by one of quite cool, is very 



HYSTERIA. 761 

useful- to assist in relieving the distended bowel, which is 
not only painful in itself, but may cause pain in the ovary 
or uterus from pressure, particularly affecting these organs 
when they are inflamed. 

Hysteria is often unsatisfactorily treated, from the fact 
that patients will often neglect treatment in the intervals of 
the attacks, when they are of recent origin, and sometimes 
when chronic, on account of the mildness of the symptoms 
and the mental weakness accompanying this condition, which 
makes the patient a poor judge of her own case and her needs. 

Kali Iro. is indicated in those women who have excessive 
sexual passion, notably young widows. 

In case hysteria is manifested during gestation either 
Bell., Hyosc, Ignatia, Aconite , Col., Nux, Puis., or Secale, are 
homoeopathically indicated, together with rest and a very 
light diet. 

When the violence of the symptoms has subsided the 
physician does well to make a physical examination of the 
pelvic organs, as well as the spinal cord and the system 
generally, in order to discover the predisposing and exciting 
causes. If they can be found they should, of course, be 
treated upon the general principles laid down in connection 
with their occurrence in other cases, and may be found under 
their appropriate heads. It is unnecessary to recapitulate 
here the proper treatment in cases of uterine or ovarian 
diseases. 

It is, however, of the greatest importance that these dis- 
eases be treated if we would cure the hysteria. It is true, 
a woman may have a single attack- of listeria owing to vio- 
lent emotions of the mind at or about the time of the men- 
strual period, and not have a recurrence of it, though she 
receive no further treatment. But these cases are excep- 
tional, and do not invalidate the general rule of the liability 
and probability of its recurrence in the great majority of 
cases when left to themselves. 



762 EATON ON DISEASES OF WOMEN. 

Special Indications for Remedies. 

Aconite — Hysterical condition, characterized with fear 
as a prominent symptom where the disease developed from 
fright, or where the prominent symptom is fear, together 
with tenderness of the uterus or ovaries; the wiry pulse; 
dizziness on rising, etc. 

Asafoetida — Hysterical condition, with burning in the 
oesophagus; sensation of a lump in the throat, termed globus 
hystericus. 

Aurum,is indicated in suicidal hysteria. 

Bell., is indicated in hysteria when there is a flushed 
face; redness of the eyes; throbbing headache over the eyes. 

Bry., when there are sharp pains in the limbs or chest, 
worse on motion, with hysterical spasms occurring only at the 
menstrual period. 

Cal. Carb.,is indicated in the leuco-phlegmatic tempera- 
ment where hysteria is manifested, where leucorrhcea is a 
complication; patient is very sensitive to cold, etc. 

Chamomilla, in hysteria, where a bad temper is a prom- 
inent symptom as a complication. 

Col., is indicated where the hysteria is complicated with 
cutting pains around the navel; gas in the intestines, etc. 

Grelsem., is indicated in hysteria, where there is also an 
intermittent fever present in the case. 

Hyosc, in hysteria, with tendency to immodesty ; tears 
come to the eyes without cause ; hysterical spasms, etc. 

Ignatia, hysteria, with silent morose condition; angry 
mood ; comes out of her spasm with deep sighing. 

Ipecac, where vomiting precedes or follows the hyster- 
ical spasm. 

Nux Vom., in hysteria with constipation, indigestion, 
loss of appetite, etc., especially in women who have been 
drinking much wine or other liquor. 

Phos., in tall, slender women with hysteria, having stool 



HYSTERIA. 763 

which is dry, hard, and narrow ; much gas on the stomach, 
which is raised after eating. 

Puis., hysteria at the menstrual periods, with partial 
amenorrhoea ; pain in the ovaries ; indigestion ; headache, etc. 

Secale, in high attenuation is indicated in hysteria with 
threatened abortion. 

Verat. Viride, hysteria, with tenderness of the spinal 
cord, with profuse perspiration. 



INDEX 



Page. 

ABORTION, 421, 675 

« etiology, ........ 422 

" symptoms, 423 

" convulsions in, 424 

" diagnosis, 425 

" prognosis, 426 

" treatment, 426 

" remedies in threatened, . . 430 
" a cause of uterine diseases, 18 

Abdominal dropsy, 739 

" supporters, . . 156, 557, 558 

" parietes failure of to ad- 

here after ovariotomy, . 334 

" gestation, 642 

Abnormal conditions, tolerance of, . . 479 
" menstruation, 34, 56, 242, 498 

Abscess of the breast, 692, 695 

" " " symptoms of, 696 

" " " etiology of, 697 

" " " treatment of, 697 

Abscess of the labia, 406, 410 

" " " etiology of, 411 

" " " diagnosis of, 411 

" " " treatment of, 412 

Abscess in inguinal glands, 652 

11 " abdominal muscles after 

ovariotomy, 335 

" " the uterus, 241 

Abscess, pelvic, 69, HO, 113, 125, 295, 718 

" etiology, 115 

" symptoms, 116 

" prognosis, 119 

" treatment, , 122, 125 

Absorption of the uterus, 753 



Page. 

Absence of the uterus, . 750, 754, op. 723 

" " " ovaries, .... 265, 754 

Ablation of the uterus, 727 

" " " cases requiring, .... 727 

" " " experience in, 727 

Acute inflammation of the uterus, . . 77 

" ovaritis, 265 

Adhesions in the vagina, .... 186, 190 

" <J labia, 186, 190 

" " " prevention of, . 195 

Adenoid tumors of the breast,. . 698, 699 
Advancing senile atrophy of female 

genitalia, 504 

Albuminuria, 662 

Alveolar cancer of the breast,. . . . 701 

Alimentation, rectal, 683 

Amenorrhcea, . ... 31, 32. 223, 242, 499 

symptoms of, 32 

etiology of, 34 

" treatment of, 36 

lt caused from psychical in- 
fluences, 35 

" simulating phthisis pul- 

monalis 36 

" causing cough, . 32, 26, 242 

" exceptional cases of, 32, 26 

242 

Amputation of the breast, 692 

" " " cervix uteri, 169 

" " " inverted uterus, .... 576 

" " " clitoris, 752 

Anaemia, 350, 358 

Anomalous cases, 577 

Antiseptic treatment, 135 



766 



INDEX. 



Page. 
Antiseptic spray apparatus, . . Plate XI. 

Anaesthetics, 368, 750, 755 

" in diagnosis, 28 

Ante-version of the uterus, . . 563, 598 
" " " etiology of, 599 

" " diagnosis of, 590 

" " " treatment of, 600 

Ante-flexion of the uterus, . . . 563, 598 
" " " etiology, . . 599 

" " " diagnosis, . 599 

" " " treatment, . 600 

Applicator, uterine, 715 

Areolar hyperplasia of the uterus, 87, 709 

711 
" " " course and termination, 100 
" " " predisposing causes, . . 101 

Sl " " symptoms, 102 

" " " prognosis, 105 

" " " treatment, ....... 106 

Artificial vesico-vaginal fistula for the 
relief of chronic cystitis, ..... 458 

Aspirators, Plates IX and X. 

Aspirator, Tiemann & Co.'s, ..... 153 

" Dieulafoy's, 154 

Ascites in Women, 739 

" " " diagnosis, .... 740 
" " " treatment, .... 742 
" " " tapping in, .... 743 
" complicating ovarian cystoma. 299 

Attenuation of remedies, 137 

Atrophy of the uterus, . . . 255, 259, 750 

Atmospheric pressure, 367, 556 

Atresia of the cervix uteri in young 

girls, 505 

Atresia of the cervix uteri in old 

women, 504 

Atresia of the hymen, ....... 197 

" " cervix uteri, ...... 502 

" " vagina, ........ 503 

11 " uterus, ... . . . . . .502 

" " cervix, artificial, .... 532 

<: '• uterus, artificial, .... 532 

BARRENNESS, 249 

" diagnosis, 255 

u treatment, 257 

Bathing, . . 744 

Battel^, combination, 38 

Faradic, 160, 714 

Babcock's Supporter, 595, and Plate VII. 



Page. 

Bantam diet, 700 

Bed swing, 338 

Bearing-down pains, 220 

Bilocular uterus 755 

Bigelow's apparatus for washing out 

the bladder, 466 

Blind vaginal fistula, 537 

Bloody tumors of the tubes, 439 

Bladder, inflammation of, 445 

" stone in, 462 

" fissures of the neck of, . . . 445 
Bozeman's tenaculum, . . . Plate XIII. 

" curved scissors, 523 

" scalpel, 63G 

Broken breast, 695, 696 

Breast, abscess of, 692, 695, 697 

" inflammation of, 691 

" cancer of, 692, 700 

" malignant tumors of, ... . 692 
" hypertrophy of, ... . 697, 698 

" tumors of, 697 

" induration of, 697 

" amputation of, 692, 702 

" " . operation for, . . 703 

" fatty tumors of, 700 

" milk tumors of, 698 

" adenoid tumors of, 699 

" malignant tumors of, ... . 700 
'' sero-cystic tumors of, ... . 699 

" hydatid tumors .of, 699 

" non-malignant tumors of, 697, 698 

" gangrene of, 697 

Broad ligament, cysts of, 437 

" " treatment, 438 

Bulbs of the vestibule, rupture of, . .490 

CATARRH, acute, of vagina, 186, 219, 240 

380 

" chronic, " 188 

" of the uterus, . . . 211, 240, 380 

li " tubes, 439 

" (; cervix, 211 

Caustics, warning against, 234 

" a cause of cellulitis, . . . -115 
Cancroid tumors of the fundus uteri, . 293 

Cauliflower excrescence, 400 

Caesarian section, 644 

Caruncles of the urethra, irritable, . . 445 

Catheter, self-retaining, . . . Plate XIII. 

" reversible, 457, 466 



INDEX. 



767 



Tage. 

Cancer of the uterus, 167, 400 

" " breast, 700 

" " tubes, ........ 439 

" " uterus, scirrhous, . 167, 400 

" " ; < encephaloid, . . 400 

" " breast, colloid, .... 700 

« " " scirrhous, . . . 700 

" " " melanoid, . . . 700 

" " " gelatiniform, . . 701 

" " " alveolar, ... 701 

" " ovary, . . . • 387 

Cancerous ulceration of vagina, . . . 629 

cachexia, .... 24, 630, 701 

Cachexia, cancerous, . . . .24, 630, 701 

" tuberculous, 24 

Catamenia, 31 

Carcinoma of the ovaries, 300 

" " uterus, 400 

" " liver, 287 

Calculi in the bladder, 462 

ureters, 462, 469 

" phosphatic, , 462 

" uric acid, 462 

" causes of, 462 

" one cause of vesico-vaginal 

fistula in some cases, . . . 463 

Causes of female diseases, 17 

Caution against uterine injections, . . 216 

Cervicitis, 211 

Cervical metritis, 79 

" hyperplasia, 103 

" endo-metritis, 218 

Cervix uteri, incisions of, 596 

indurations of, 162 

hypertrophy of, .... . 162 
lacerations of, . 115, 539, 550 
" a cause of hypertrophy, 166 
" " areolar hyperplasia, 102 
artificial atresia of, . . .532 
cancerous diseases of, . . 400 

stenosis of, 452 

atresia of, . 502 

tumors of, 343 

amputation of, 169 

Cellulitis, pelvic, 110, 113 

" description of, 113 

" symptoms of, 116 

" chronic, . 117 

" prognosis of, 119 

" treatment of, 122 



Page. 
Chronic inflammation of female gen- 
italia, ...... 62, 70, 87 

cellulitis, 117 

" cystitis, 458 

" parenchymatous metritis, . . 87 

Chancre, Hunterian, 657 

soft, 657 

" hard, 657 

Chapter on Instruments, 142 

Chancroid sore, 657 

Child-bed fever, 126 

Chair for examinations, 22 

Chlorosis, 32, 754 

Chills caused from retro-version of the 

uterus, 25 

Change of life, 494 

Civiale's lithotriptor, .... Plate VIII. 

Clitoris, amputation of, 752 

" elephantiasis of, 723 

" hypertrophy of, 723 

" cases of, 724 

Clitoridectomy, 752 

Clamp for pedicle in ovariot- 
omy, 160, and Plate XV. 
" " Thomas', " " 

" " Spencer "Wells', " " 
" " Dawson's improved, . . 321 

Climacteric period, 494 

" " treatment of diseases of, . 500 

Conjoined manipulation, 28 

Cold vaginal injections injurious, 701, 746 

Colostrum, 694, 695 

Combination battery, 38 

Complications of metritis, 82 

Coccygodynia, 396 

Color of the discharge in endo-metritis, 220 

" " " endo-cervicitis, 212 

Cover for use in examinations, ... 30 

Colpeurynter, 45, 350, 364 

Colpeurysis, 45 

Corporeal hyperplasia of the uterus, . 104 

Colic, uterine, ....•• 586 

Copulation, injurious effects of, . . . 83 
Convulsions in the puerperal state from 

albuminuria, 662 

" in hysteria, 759 

Crabs, 408 

Cutler's forceps and suture cutter, . . 535 

Cut of fistula, 524 

Curved scissors, 530 



768 



INDEX. 



Page. 

Curved scissors, long, 146 

Cystitis, 455 

" symptoms, 455 

etiology, 455 

" treatment, 457 

Cystocele, 389, 891 

Plate XVI. 

Cystoma ovarii, 298 

Cystin calculi, 462 

Cysticercus, 356 

Cysts of the ovary, 280 

" " broad ligament, . . 301, 437 

*' vaginal, 406, 414 

" " pathol. anatomy, . . . 414 

" " etiology, 414 

" " diagnosis, 415 

" " treatment, 415 

" of the uterus, ........ 356 

" " ovary, rupture of, ... . 310 

" " " permanent opening into, 309 

DAWSON'S improved Sims' speculum, 

Plate III. 

Dead foetus in utero, 29 

Denidation, 49 

Decidua (nidal), 49 

Dermoid cysts, ...... 267, 277, 278 

Diet, Bantam system of, 700 

Dilutions, homoeopathic, 138 

Diphtheritic inflammation of the 

vagina, 186, 194 

Diathesis seu Infectio purulenta, . .136 
hemorrhagic, .... 203, 493 

Diagnosis, general, 21 

" of female diseases, . . 21 
of adhesions in ovarian tumors, 296 
differential, " " " 283 

of inversion of the uterus, . . . 567 
difficulties of in inversion of the 

uterus, . 568 

Displacements of the tubes, . . 439, 443 

" " ovaries, .... 385 

of the uterus, . . 552, 663 

" " " symptoms, 561 

" " " etiology, . 561 

" " treatment, 562 

Diseases, female, causes of, .... . 17 

Dilator (Emmet's sponge tent), Plate IX. 

" Palmer's uterine, 146 

Discharge, color of in endo-metritis, . 220 



Page 
Discharge, color of in endo-cervicitis, 212 

Diseases of pregnancy, 660 

" of the ovaries, 265 

" uterus, sympathetic, 472, 487 

" tubes, 439 

" " urethra, 445 

" " " treatment of, . . 448 

" sympathetic, 472 

of the breasts, 692 

Double tenaculum forceps, 323 

" uterus, 754 

" cervix uteri, 755 

Drainage tube, 333 

Dropsy in women, 739 

" " " diagnosis, .... 740 
" " " treatment, .... 742 
" of the Fallopian tubes, . . .301 

Dyspareunia, 162, 173 

" symptoms, 173 

" etiology, 175 

" treatment, 176 

Dysuria, 646 

" treatment of, 648 

Dysmenorrhoea, 46 

" diagnosis, 47 

" prognosis, 50 

" treatment, ..... 50 

EATON'S needle-holder, . . 145, 521, 527 
Fig", of, Plate VI. 
Eaton's wire holder and twister, 146, 522 
" " Fig. of, Plate VI. 
Eaton's improved London sup- 
porter, . . . 158, 665. See Plate XII. 
Also uterine displacements. 

Ecraseur, 369 

Edwards' ecraseur, 369 

Effects of conception in cases of endo- 
metritis, 223 

Effects of uterine disease, 17 

Elevators, uterine, 159 

Elevator, Sims', 159 

Elliott's, 159 

Elevators, uterine, .... See Plate XVI. 

Elevation of the uterus, .... 563, 577 

Plate XXVIII. 

Electrical batteries, . . 38, 159, 160, 714 

Electrolysis needles, 160, 370 

" in ovarian cystoma, . . 309 
Electrical baths, . . 745 



INDEX. 



769 



Page. 

Electricity, 479 

" in treatment, of atrophy of 

uterus, . . . 754 
" " " amenorrhcea, 37, 479 
" " " sub-involution, . 714 
" " " uterine fibroids, . 349 

Elongation of cervix uteri, 164 

Elytroplasty, 536 

Elephantiasis of the clitoris, .... 723 

" " labia majora, .... 723 

" " " minora, .... 723 

clitoris, . . Plate XXIX. 

" " labia majora, Plate XXX. 

" " " minora, Plate XXXI. 

Elytrorrhaphy, .... 392, 393, 617, 623 

Elasticity of the connective tissue in 

the pelvis, . . . 367 
" " uterine tissue, 163, 390 

Emmet's sponge dilator, 151 

... Plate IX. 

" curved scissors, 726 

" sponge tent applicator, . 366, 597 

Endo-metritis, 218, 253 

effects of, 225 

Endo-cervicitis, 211, 253 

Endometrium, vegetations of, 352, 353, 355 
" granulations of, . . . .353 

" inflammation of, . 218, 253 

Enucleation of submucous fibroids, 347, 348 
Enucleator, Sims' (three figures), . . 347 
Encephaloid cancer of the breast, . . 701 

Euterocele, 389 

Endoscope, urethral, 446 

Enlargement of the clitoris, .... 723 

" labia majora, . . 723 

" " " minora, . . 723 

Enuresis, 647, 648 

Episiorrhaphy, 537 

Ephemera, 695 

Ergotine injections in uterine fibroids, 348 

Extirpation of the breast, 702 

Exsection " " 702 

Extirpation of the uterus, . . . 346, 727 

Examination table, 319 

chair, 22 

rectal, 30 

Extra-uterine pregnancy, . . . 286, 642 

Excoriated nipples, 692 

Examination of virgins, 24 

Excessive venery a cause of sterility, 255 



Page. 

FALSE pregnancy, 375, 498 

" peritonitis, 131 

Fallopian tubes, diseases of, .... 439 

" " cancer of, 443 

" " fibroma of, 443 

" " displacements of, . . 443 

« dropsy of, . . . 439, 301 

Facies ovariana, 283, 285 

Faradic battery, 38, 160, 714 

Femoral hernia, 404 

Fever, hidrotid, 130 

" puerperal, 126 

" child-bed, 136 

" milk, 694 

Female genitalia, .... Plates I and II. 
" " adv. senile atrophy of, 504 

Fissures of the vagina, 630 

" " nipple, 692 

" " anus 260 

" " neck of the bladder, . 445 

Fibroids, uterine, 292, 302, 342 

" " diagnosis from pregnancy, 345 

" " varieties of, 343 

" " symptoms of, 343 

" " pi'ognosis, 345 

" « treatment 346 

" " a by sponge tents, 349 

" " subserous, 343 

" « « treatment of, . 347 

" " submucous, 343 

" " treatment by enucleation, 347 
" " " by other operations, 348 

" " pedunculated, 343 

" of the cervix uteri, 343 

of the Fallopian tubes, ... 439 
Fibro-cysts of the uterus, . . . 302, 346 

Fibi'oids of the vagina, 406, 414 

Fibroma, uterine, 302 

vaginal, 406, 417 

Fibi-ous tumors of the uterus, . . 342, 352 

ovary, .... 300 

" cervix, . . 342, 352 

" " " vagina, . . 406, 417 

Fitch's supporter, 158 

Fistulas, vaginal, 511 

" " Sims' operation for, . 534 

" " Simon's « " . 535 

" in ano, 511 

" " treatment, 533 

" vesico-vaginal, 511 



49 



770 



INDEX. 



Page. 
Fistulas, vesico-vaginal, treatment., . 516, 

520,523 

recto-vaginal, 511 

" treatment, 528 

vesicocervical, 511 

" treatment, 516 

urethrovaginal, 511 

" treatment, .... 516, 526 

intestino-vaginal, 511 

" treatment, 532 

recto-vesical, 511 

" treatment, 532 

ureto-vaginal, 511, 532 

" etiology, 512 

" diagnosis, 515 

" treatment, 532 

Forceps, vulsellum, Plate X. 

lithotomy, Plate VII. 

uterine dressing, . Plate V, 184 
Nelaton's tumor, . . . Plate XI. 
Front view of uterine organs, . . Plate I. 

GANGRENE of the breast, 697 

" " ovary, 268 

Gastralgia, 748 

Galactocele, 695 

Gelatiniform cancer, 701 

General diagnosis, 21 

Gentleness in examination, 23 

Genitalia, inflammation of in female, 62 

Gestation, abdominal, 286, 642 

" " diagnosis, . . . 643 

" " prognosis, . . . 644 

" " treatment, . . . 644 

" interstitial, 643 

" " diagnosis, . . . 643 

" "■ prognosis, . . . 644 

" " treatment, . . . 644 

tubal, 440 

" extra-uterine, ...... 286 

Glandula coccygea, 398 

Globus hystericus, 73, 759 

Gonorrhoea in women, 650, 62 

" " " etiology, 650 

" " " symptoms, .... 651 
" " " buboes in, .... 653 
" " " " treatment, 653 

" " young girls, 653 

" " " treatment, .... 654 
Granulations, of the cervix uteri, . . 353 



Page. 

HJEMATOMETRA, . . 198, 345, 502, 505 

" simulating ovarian cystoma, . 294 

Hematocele, recto-vaginal, 287 

" recto-uterine, 718 

" pelvic, 716 

" " etiology, 716 

" " symptoms, .... 717 

" " diagnosis, .... 719 

" " prognosis, .... 720 

" '* treatment, .... 721 

" pudendal, 490 

Heartburn, 748 

Hernia in women, 404 

" of the ovary, 385 

" " " treatment of, . . . 388 

" " " crural, 386 

" " " ischiatic, .... 386 

" " " vaginal, 386 

" " " uterus, 385 

" femoral, 404 

" inguino-labial, 404 

" inguinal, 385, 404 

" labial, 385, 404, 491 

" vaginal, 404 

Hemorrhage, 201, 222, 350 

uterine,. .201,222,254,500 

" " etiology, 202 

" " diagnosis, .... 205 

" " treatment, .... 205 

" " sponge tents in, . 349 

" pudendal, 490 

" after ovariotomy, .... 331 

" " " treatment of, 332 

Hemorrhagic diathesis, 203, 493 

Hemiplegia, 484 

Hermaphrodites, 723 

...... Plate XXIX. 

Hemorrhoids, 260 

Hidrosis, . 130 

Hip baths, 745 

Hidrotid fever, 130 

" " varieties of, 130 

Homoeopathic remedies, 137 

" " attenuations of, . 137 

" " trituration of; . . 136 

" . dilution of, . . .138 
" " fluxion process, . 138 

" " action of, . . . .139 

How to make a diagnosis, 21 

Hunterian chancre, 657 



INDEX. 



771 



Page. 
Hunterian chancre, treatment of, . . 659 

Hydrometra, 400 

Hydatids of the breast, 699 

uterus, 352, 353, 356, 372 
" " treatment of, . 372 

Hymen, imperforate, 26, 197 

" atresia of, 197 

Hyperplasia, areolar, of uterus, ... 87 
" cervical, " " ... 103 

" corporeal," " ... 104 

Hydrosalpinx, 301, 439 

Hyperesthesia, 480 

" etiology, 480 

" pathology, 481 

" diagnosis, 482 

" prognosis, 483 

Hydrops, folliculi, 277 

" folliculorum, 298 

tubal, 439 

Hydrocele in women, 404 

" " u treatment, . . . 405 

Hysterotomy, 727 

Hysterotomes, 145, 453 

Plate V. 

Hysteralgia, 736 

Hyper-involution of the uterus, . 750, 752 

Hypertrophy of the clitoris, . . . 223, 751 

" ' « ' ; Plate XXIX. 

" ' ; labia majora, . 723, 725 

" " " Plate XXXI. 

" " " minora, . 723. 724 

" " « Plate XXX, 

" " " treatment, 726 

" " nymphae, 724 

" " " treatment, . 726 

" uterus, . . 162, 219, 710 

" " cervix uteri, . . 162, 253 

169, 219 

" " breast, 698 

Hysteria, 757 

Hysterical mania, 760 

" spasms, 759 

" convulsions, 759 

" paralysis, 486 

Hysterocele, 385 

INTRODUCTION, 17 

Imperforate hymen, 26, 197 

Inversion of the uterus, 563 

" " " etiology,. . . 565 



Page. 

Inversion of the uterus, diagnosis, . . 567 

" " " treatment, . . 569 

Inguinal hernia, 404 

Inguino-labial hernia, 404 

Intra-uterine stem, 593 

Inverted uterus, 563 

" " amputation of, 576 

" " etiology, 565 

" " diagnosis, 567 

" " treatment, 569 

u u errors in diagnosis, . . . 568 

" " recent, 570 

" " chronic, 571 

" " *' operations for, . . 572 
" " " " White's method, 573 
" " " " Barnes' " 575 
" " " " Simpson's " 575 
" " " " Thomas' " 575 
" " " " Watts' " 575 
" tl spontaneous reduction, . 576 
" " anomalous cases of, . . • 577 
Injections of iodine in ovarian cys- 
toma, 304 

" ergotine in uterine fibroids, 348 

Infractus, 93 

Indigestion, 487 

Induration of the cervix • . 162 

" " " etiology, . . . 155 

" " " pathology, . . 165 

" " " diagnosis,. . . 166 

" " " treatment, 167, 171 

" " " local " 171 

" " breast, 697 

Inflammation of the female genitalia, 60 
■" " bladder, .... 455 

" " vagina, 186 

" u Fallopian tubes, . 439 

u acute, of female genitalia, 62 
" chronic, " " 62, 67 

sub-acute, 62, 64 

" chronic sub-acute, . . 62, 70 

" of the breast, 671 

v " " urethra, 445 

" diphtheritic, of vagina, . 194 

Intestino- vaginal fistula, 511 

Instruments, chapter on, 142 

Interstitial pregnancy, 643 

" gestation, 643 

Injections into the uterus, 171 

" of wine, in ovarian cystoma, 308 



772 



INDEX. 



Page. 
Intra-uterine medication, .... 229, 713 
Injury to the spine, causing urinary 

calculi, 462 

Insanity, 688 

" caused from uterine diseases, 479 
Incisions of the cervical canal, . . . 596 

Intestinal inhaustion, 684, 685 

Inhaler, Lente's, 156 

" Plate XI. 

Iodine injections in ovarian cysts, . . 304 

« " not painful, .... 309 

Irritable urethral carunculse, .... 445 

uterus, . 93, 736 

Ischuria, 646 

" treatment, 648 

KOLPOKLESIS, 537 

Kent's nipple shield, 694 

LATERAL displacements of the 

uterus, 563, 603 

Lacteal tumor of breast, ....... 698 

Laceration of the perineum, . 629, 631, 635 

" " " etiology, 630 

" " " diagnosis, 632 

" " " treatment, 633 

" " " operation for cure of, 634 
" " " time for operating, . . 639 
" " " removal of sutures, . 640 

" « urethra, 445, 449 

" " cervix uteri, . . .115, 539 
" " " a cause of cellulitis, . 115 

" " vagina, 629 

'< " " treatment, 630 

" " cervix, etiology, .... 541 

'' " " diagnosis, 545 

<< " '' treatment, . . . . . 550 

Labia, adhesions of, 186, 190 

" hernia into, 404, 491 

" tumors of, 726 

" abscess of, 406 

" " " etiology, 407 

" " " diagnosis, 408 

" " " treatment, 409 

" hypertrophy of, 723 

Leucorrhcea, 240, 670 

" vicarious of menstruation, . 34 
" color of discharge, .... 240 

'' diagnosis, 240 

" treatment, 242 



Page. 

Leucorrhcea, remedies in, . . 243, 244, 246 

" special indications for, . 245 

246,247 

Lente's inhaler, 156 

" " Plate XT, 

Ligatures, 169, 346 

Ligature cutter, 535 

Lithotomy in women, 465, 467 

Lithotrity " " 465 

Lithectasy " " 465 

Lithotriptor, Plate VIII. 

Lithotomy forceps, Plate VIII. 

Little's antiseptic spray apparatus, . 156 
" " " " Plate XI. 

Local anaesthesia, 756 

London supporter, Plate XII. 

'' " Eaton's improved, 158, 665 

" Plate XII. 

Long curved scissors, 146 

" " trocar, 125 

" " " uterine, r . . . . 510 
Luska's gland, 398 

MAMMITIS, ..• 695 

Mastitis, 695 

Mammary abscess, 695 

Malformation of the uterus, . . 750, 754 

Mania, puerperal, 688 

" hysterical, . . . 760 

Malignant tumors of the breast, . . . 697 
" " " " scirrhous, . . 700 

" " " " encephaloid, 700 

" " " " melanoid, . . 700 

« " " " colloid, . . .700 

" " " " gelatiniform, 701 

" u ■ ti « alveolar, . . 701 

" of the uterus, . 395, 400 
" " " " scirrhous,. . 400 

" " » " encephaloid, 400 

" " of the breast, . . . 700 

" " < ! Fallop'n tubes, 439 

Metrorrhagia, 41 

Menorrhagia, 41, 222 

" etiology, 42 

" treatment, 43, 45 

Metro-phlebitis, 126 

" peritonitis, 126 

Menstruation, 19, 31 

idiosyncrasies of, 19, 31, 32, 242 
" vicarious, 34 



IXDEX. 



773 



Page. 
Menstruation, time of cessation, . . .494 

arrest of, 31, 223, 242 

suppression of, . . 31, 223, 242 

" " symptoms, 32 

" etiology, 34 

" " prognosis, 3G 

" " treatment, 36 

" " caused from psychical 

influences, .... 35 
" " simulating phthisis, . 36 

" profuse, 41 

" excessive, 41 

" painful, 46 

Method of making vaginal examina- 
tions, 21 

Medicated suppositories, .... 229, 713 

Metatithmenia, 719 

Menopause, 496 

Medicated bntlis, 



745 

Metritis, acute, 77 

" " diagnosis, 78 

'* cervical, 79 

" " treatment, 80 

" complications of, 82 

" tendency to dropsy in, ... 82 
" / amaurosis caused from, . . 83 
" sterility " " . . 83 

" abortion " " . . 83 

" menstrual derangements 

caused from. 84 

" remedies in, 84 

" general effects of, 83 

" chronic parenchymatous, . . 87 

Milk-leg, 705 

" diagnosis, . . . „ 706 

" etiology, 707 

u treatment, ........ 708 

Milk tumor of breast, 698 

" fever, 694 

" abscess, 695 

" diet, . 70 

Mono-cysts of the ovary, 298 

Morphia, hypodermic injection of, . . 81 
" " " " objections to, 81 

Moles in the uterus, . „ 375 

" " " etiology, . '. 375 

" " " deficiency of spermatozoa 

a cause of, 376 

ct u u diagnosis, 376 j 

« a u prognosis, 376 | 



Page. 
Moles in the uterus, treatment, . . . 376 
Mucous polypi of the uterus, .... 352 

" patches, (355 

Myoma of the tubes, 439 

NEURALGIA of the uterus, .... 736 
" ovaries (see Dysmenorrhoea), 46 

Neuromata of the vulva, 739 

Nelaton's tumor forceps, 365 

... Plate XI. 

Neck of the bladder, fissures of, . . . 445 

Nelson's tri-valve speculum, .... 143 

. . Plate IV. 

Needle-holder, Eaton's, 145 

.... Plate VI. 

Sims', 520 

Needles, electrolysis, 160. 370 

" '• in ovarian cystoma, . 309 

Pease's, 148 

suture, Plate XIII. 

" open-eyed, 326 

Non-malignant tumors of the ovaries, 275 
" uterus, 352, 395 
" breast, 698, 699 

Nipple shield (Kent's), 694 

" excoriated, • ... 692 

" fissured, 692 

" retracted, 693 

Nidation, 46, 49 

Nidal decidua, 49 

Nonentities, 723 

" or hermaphrodites, . . . 723 

Plate XXIX. 

Normal position of the uterus. . . . 554 

" " " " Plates I and II. 

Non-malignant tumors of the breast, 697 

" " " " fatty, 700 

" " " " fibro-cystic, . . .346 

" " of the uterus, 352 

" u u u fibroid, 292, 302, 342 
" " " " subserous, . . .343 
" " " " submucous, . . .343 

« " of the labia, 726 

" t: of the ovary, 294 

» " " " cystic, 294 

" " " " fibro-cystic, .... 294 

" " " " fibroid, 300 

" " of the .Fallopian tubes, . . 443 

Nott's depressor, 522 

Nursing sore mouth, • . 747 



74 



INDEX. 



Page. 

Nymphomania, 724, 750 

" . etiology, 750 

" symptoms, 751 

" diagnosis, 751 

" treatment, 752 

Nymphse, hypertrophy of, 724 

OBJECTIONS to abdominal support^ 

ers not tenable, 158 

Objections to the ligature in the re- 
moval of uterine polypi, 367 

Occlusion of the Fallopian tubes, . . 439 
" " " " congenital, 442 

Oligocysts of the ovary, 298 

Open-eyed needle, 326 

Opium habit, remarks on, 81 

" " statistics of, 81 

Operations for stone in the bladder, . 467 

Operating table, 319, 703 

Opisthotonos, 759 

Os uteri, ulceration of, 179 

" " " " treatment,. . .185 

« « virgin, 26 

" " in old age, 27 

" " after lacerations, 162 

Ossification of the arteries a cause of 

atrophy of the uterus, 753 

Ovaries, prolapse of, 417 

" " " treatment, . . . 419 

" displacements of, 385 

" hernia of, 385 

" " removal by operation, 

cases of, 388 

" diseases of, 265 

" malformation of, 265 

" cancer of, 387 

" carcinoma of, . . 300 

" papilloma of, 395 

" enchondi'oma of, 300 

" osteoma of, . . 300 

" fibroid tumors of, 300 

" inflammation of, 265 

" cystic tumors of, 298 

" fibro-cystic tumors of, . . . 298 

" oligocysts of, 298 

'' dermoid cysts of, 275 

" gangrene of, 268 

Ovaritis, 265 

" chronic sub-acute, 266 

etiology, 268 



Page. 

Ovaritis, diagnosis, 268 

" treatment, 269 

Ovariocentesis, 310 

Ovariocele, 389 

Ovai'ian cyst, rupture of, 310 

" " permanent opening into, 309 

" Tumors, 275 

" " classification of, 275 

" " etiology, 276 

" " symptoms, 281 

" " differential diagnosis, .... 283 

" " prognosis, 303 

" " treatment, 303 

" " diagnosis from cellulitis, . . . 288 
" " " from enlarged liver, .... 287 

" « " " fecal tumors, 287 

" " " " retro-uterine hsemotocele, . 287 
" " " " abdominal ascites, .... 290 
" " " " hydatids of the omentum, . 291 
u u u u C y St f t jj e u terus, .... 294 
" " " " dropsy of the amnion, . . 293 
" " " " floating kidney, ..... 292 

" " " " pelvic abscess, 295 

" " " " distended bladder, . . . 295 

u « u u pregnancy, . 285 

" " " " extra-uterine pregnancy, . 286 

" " " " uterine fibroids. 292 

" " " " carcinoma of fundus uteri, . 292 
" " " " haematometra, ...... 294 

" " " " cyst of the broad ligament, 301 

" " " " hydrosalpinx, 301 

" " " " cysts of mesenteric glands, . 302 
" " " " fibro-cyst of the uterus, . . 302 
" " " comparative differential, . . 296 

" " " of adhesions of, 296 

" " conditions mistaken for, . . . 289 

" " varieties of, 275 

" " causes of, 276 

" " derangements of mentruation in, 279 

" " sterility as a cause, 279 

" " sometimes congenital, .... 280 
" " " " case, . . . 281 

" " rectal examination in, .... 282 
" " stages of development, .... 283 

" " treatment, 303 

" " " by iodine injections, .... 304 

" " " surgical, 312 

" " " medical, 272 

" " experience in tapping and in- 
jecting, 305 



IXDEX. 



775 



Page. 
Ovarian tumors, use of gum-elastic 

tube iu, 308 

" " wine as an injection in, . . 308 
" " iodine " " " . . 304 

" " modus operandi of treatment 

by injection, 309 

" (i electrolysis in treatment, . . 309 
" cystoma, spontaneous rupt're of, 310 

» fibroids, 300 

" cyst, rupture of, 310 

" " permanent opening into, . . 309 

Ovariotomy, 312 

« history of, 312, 313, 314 

" objections to, 314 

" when should it be performed? . 315 

" causes of death from, 31G 

" when it should be abandoned, . 316 
" when improper, ...... .318 

" preparatory treatment, .... 317 

" time of the year for, 318 

" place, 318 

" the operation for, by gastrotomy, 321 
'< different methods of operating, 328 

" vaginal, 335 

" treatment of the pedicle in, 325, 328 

" " after operation, 327, 331 

" " of pedicle by torsion, .... 329 
" " " by tors' n of separate vessels, 329 

" " " by the clanip, 329 

" " " by ligature, 328 

<' hemorrhage after, . . . .331, 332 
" septicaemia or pyaemia after, . . 332 
" " " « " treatment, 333 

" vomiting after, 333 

" abscess in abdominal muscles 

after, 335 

PAINFUL menstruation, 46 

Papilloma of the ovaries, 395 

Papillary tumors of the ovaries, 301, 395 

" " " uterus, . . . 395 

" " « treatment, 396 

Paraplegia, 484 

" diagnosis, 485 

" treatment, 486 

Paralysis, 484 

" diagnosis, 485 

" treatment, 486 

" hysterical, 486 

Parenchymatous metritis, 87 



Page. 
Parenchymatous metritis, Dr. Thomas 

on, ....... 89 

" Dr. H. Bennett on,. . . 90 

" Dr. Graily Hewitt on, . 92 

" " Dr. Noeggerath on, . . 92 

" Dr. Peaslee on, .... 92 

" " Dr. Kammerer on, ... 93 
" " Dr. Kiwisch on, .... 93 

" " Sir James Simpson on, . 95 

" " Pathology of, 95 

" Dr. West on, . . . 97 

" " Dr. Snow Beck on, 97 

" " course and termination, 100 

" " predisposing cause, . . 101 

" " exciting " . . 101 

" " symptoms, 102 

" " physical signs, . • 103, 104 

" u prognosis, 105 

" " treatment, 106 

Palliative treatment in uterine 

fibroma, 349 

Palmers uterine dilator, 146 

" . . Plate VIII. 

" " applicator, 715 

Patient, efforts of, to mislead the physi- 
cian as to her disease, 19 

Pains, bearing-down, 220 

Para-metritis, 113 

Paquelin thermo-cautere, 460 

Pain in the sacral region as a 

symptom, 221 

" " loins as a symptom,. . . 221 

Peri-metritis, 110, 218 

" " symptoms, 110 

" " etiology 3 Ill 

" " sequelae, 112 

treatment, Ill 

Pelvic cellulitis, 110, 113 

" " etiology, 115 

" " symptoms, 116 

" " prognosis,, 119 

" " treatment, . . . ■ . . . .122 
" " complications of, .... 120 
" " caused from lacerated cer- 
vix uteri, 115 

Pedicle of ovarian tumors, . . . 300, 328 
" clamp in ovarian tumors, . . 160 

" " " " Dawson's, 321 

" " " " Spencer Wells' original, 

Plate XV. 



776 



INDEX. 



Page. 
Pedicle clamp in ovarian tumors, new, 

Plate XV. 
« " " '"' » " Thomas', Plate XV. 
" " " " objections to, ... . 329 
" " " " advantages of, . . . 329 
" treatment of, in ovariotomy, . . 328 

" " by crushing, 328 

" " " ligature, 325, 328 

" " " the actual cautery, . . . 328 
" " " torsion of separate vessels, 329 
" " " transfixing it to the abdo- 
men, 330 

Pediculi, 408, 409 

Peri-vaginitis phlegmonosa dissecans, 195 

Pelvic lisematoma, 716 

" hematocele, 716 

" " source of the hemorrhage in, 716 

" " etiology, 716 

" " symptoms, 717 

" " differential diagnosis, . . . 719 

" " prognosis, 720 

" " treatment, 721 

" abscess,. ..... .110,295,718 

" " etiology, 115 

" " symptoms, 116 

" " prognosis, 119 

" " treatment, .... 122, 125, 722 

Peaslee's improved perineum needle, . 147 

" Plate VI. 

Pease's needle, 148 

Pessaries, vaginal, . . 148, 236, 593, 603 
" " the use of abdominal support- 
ers in connection with, . 149 

" " elastic, 149 

" " cap and stem, .... 149, 150 
" " objections to, ... . 148, 149 

Perineum needles, 147 

" lacerations of, ... . 629, 631 

« " diagnosis, 632 

" " treatment, ..... 633 

" " operation for, .... 634 

« time of, . . . 639 

" " removal of sutures, . 640 

Peri-uterine hematocele, 718 

Perineorrhaphy, 623 

Peritonitis, puerperal, 126 

" " symptoms, . . . 129 

" " etiology, .... 131 

" " prognosis, . . .132 

" " complications, . 132 



Page. 
Peritonitis, puerperal, treatment, . . 133 

false, 131 

Peritoneo-vaginalfistula, . . .537,538 
" " treatment of, 538 

Perineovaginal fistula, 537 

" " " treatment of, . 538 

Phlegmasia dolens, 705 

" " diagnosis, 706 

" " etiology, 707 

" " treatment, 708 

" " post-mortem appearances, 707 

Physometra, 295 

Placenta previa, 204 

Placental polypus, 354 

Polypi of the urethra, 445 

Polypi of the uterus, 352, 354 

" " " fibrous, .... 352, 353, 354 

" " " etiology, 354 

" " " diagnosis, 357 

" " " differential diagnosis, . . 360 

" " " prognosis, 362 

" " " treatment, 363 

" " " operation for removal of, 364 
" " " use of ecraseur in, . . . 369 

" " " vascular, 352 

" " " " treatment, • • • . . 372 

" " " placental, 354 

" " " mucous, 352 

« " « hydatid, . . . 352, 353, 356 
" " " cystic, ...... 353, 356 

« « " ligature in treatment, . . 367 
« « " sponge tents in « 365, 369 
" " " removal by torsion, . . . 367 
" " " treatment of cystic, . . . 371 
" " " " " hydatid, . . 372 

" " " (small) treatment, . . . 373 

Polypi of the vagina, 406, 417 

Potencies, 137 

Poly-cysts of the ovary, 299 

Pruritus vulvas, 406, 664, 670 

" " etiology, 407 

" " diagnosis, 408 

" " treatment, 409 

Prolapsus uteri, • 563, 605 

" " etiology, 606 

" " pathology, 606 

" " symptoms, 613 

" " differential diagnosis, . 614 
u " causing throat trouble, 29 
" " treatment, 215 



IXDEX. 



i t i 



Page. 
Prolapse of the ovaries, . . 406, 417, 419 

" " vagina, 389 

" « " etiology, . . .389 

" " " diagnosis, . . 390 

" " <c treatment, . . 391 

" " urethra, 445 

" " bladder, 389 

Procidentia uteri, 563, 605 

" " etiology and pathol., . 606 

" " symptoms, 613 

" " differential diagnosis, . 614 

" " treatment, 515 

" " surgical, . . 623 

Processus vaginalis peritonei, . . . 385 

Pregnancy, false 375, 498 

' ; diseases of, 660, 672 

tubal, 440, 642 

" " treatment, 442 

" extra-uterine, . . . 642, 286 

" " " diagnosis, . . 643 

" " " prognosis, . . 644 

" " " treatment, . . 644 

" abdominal, 642 

" molar, 375 

" vomiting in, .... 668, 672 

• ( " etiology, 673 

" " ti^atment. 674 

" " shall abortion ever be 

induced to relieve? 675 

Primary syphilis. 657 

Pressure, effect, of in uterine polypi, . 369 

" atmospheric, 367, 556 

" " in treatment of uterine 

displacements, 367, 556 

Pseudocyesis, 498 

Puerperal fever, 126 

" mania, 688 

" metritis, 126 

" phlebitis, 705 

'• peritonitis, 126 

" " symptoms, 129 

(: lt etiology, 131 

ft it prognosis, 132 

" " complications, 132 

"' " post-mortem appearances, 133 

" " treatment, 133 

Pudendal hemorrhage, 490 

" » treatment, . . .492 

" hematocele, 490 

" < ; treatment, . . . 492 



Page. 

Puberty, 494 

" treatment of diseases of, . . 498 

Pyosalpinx, 439 

Pyaemia after ovariotomy, 332 

QUILL suture, 637 

'' l: adjusted, ...... 638 

" " " cut of, . . , 638 

RAPID dilatation of os uteri, .... 146 

Rectal examination, 30 

' ; alimentation, 683 

Rectocele, 389 

Retractexl nipples, 693 

detention of urine, 646 

" " " treatment, .... 648 

Recio-vagiual fistula, 511 

< : " " treatment, . 528, 531 

<■ vesical " " . 511, 531 

Rectitis as a complication of pelvic 

cellulitis, 121 

Removal of sutures, 535 

Retro-uterine hematocele, . . . 287, 716 

" <; ". symptoms, 717 

" " " differential diagnosis, 719 

" " " prognosis, 720 

li " " treatment, 721 

Recto-vaginal hematocele, . . . 716, 287 

:t " " symptoms, 717 

" " " differential diagnosis, 719 

" " u prognosis, 720 

" " " treatment, 721 

Remedies homoeopathic, 137 

Reversible eatheter, 457, 466 

Removal of the ovaries for hemorrhage 

caused by uterine fibroids, .... 351 

Retro-version of the uterus, 563, 578, 663 

" " " " etiology , . . 579 

(; " '"' " diagnosis, . . 581 

" " " treatment, . . 587 

" " " " in pregnancy, 589 

Retro-flexion of the uterus, . . . 563, 578 

" " " " etiology, . 579 

" " '' " diagnosis, . 581 

Ci " ' ; " treatment. . 587 

Remedies in acute ovaritis, 269 

" " amenorrhcea, .... 36 
" " areolar hj^perplasia, . . 107 

" » cystitis 461, 467 

" " dvsmenorrhoea, .... 54 



778 



INDEX. 



Page. 

Remedies in hysteria, 462 

" '' leucorrhoca, 243 

" " menorrhagia, 44 

" " metritis, 84 

11 '•'■ pelvic cellulitis ,. . . . 122 

" " peri-metritis, Ill 

" ll prolapsus uteri, .... 620 
" " puerperal mania, . . .691 
" " " peritonitis, . 134 

" " " phlebitis, . . 708 

" " sterility, 261 

" " stomatitis ma tern a, . . 749 
" " stone in the bladder, . . 470 
" " sympathetic affections, . 487 
" " threatened abortion, . . 429 

" "• vaginitis, 217 

Round elastic pessary, 149 

Rupture of the bulbs of the vestibule, 490 
" spontaneous, of the uterus, 

from uterine fibroids, . . 351 

SARCOMA of the uterus, . . . 400, 402 

Salpingitis, 439 

Sclerosis " " ... 100, 105 

Scirrhus " " 400 

" " breast, 700 

Sero-cystic tumors of the breast, . . 698 
Sexual intercourse a cause of inflam- 
mation, . 60, 224, 233 
" " interdicted in pregnancy, 669 

Septicaemia, 332 

Septsemia, 332 

Sea-tangle tents, 230 

Simple vaginal fistula, 537 

Sims' operation for vesico-vaginal 

fistula, 534 
Simon's " ■ " " " 535 

Sims' vaginal dilator, Plate VI. 

" original speculum, . . . Plate III. 
" << " ...... 142 

11 folding " 142 

" ... Plate III. 

" uterine elevator, 159 

« •< « ... Plate XIV. 

" enucleator, 347 

Simpson's sound, 144 

Plate V. 

'' hysterotome, 145 

Plate V. 

Sound, uterine, • 22 



Page. 

Sound, uterine, Skene's, 144 

" Plate V. 

" " steel, 144 

" " Plate V. 

" l( Simpson's, 144 

.... Plate V. 

" hard rubber, 144 

Spontaneous rupture of the uterus in 

uterine fibroid, 346, 362 

Spencer Wells' clamp, 160 

.... Plate XV. 
" " original clamp, Plate XV. 

trocar, 320 

" " artery forceps, .... 322 

Spasms, hysterical, 759 

" puerperal, 662, 666 

Speculum, Wocher's bi-valve, .... 143 
" " " . Plate IV. 

" Nelson's tri- valve, .... 143 
. Plate IV. 
" Ferguson's mirror, .... 143 
" « " . Plate IV. 

" Sims' original, 142 

"... Plate III. 

" folding, 142 

41 ... Plate III. 

" " Dawson's improved, . 142 

« " << Plate III. 

Sponge tents, . . . 150, 230, 349, 350, 365 

: . . 602, 713 

" " in treatment of fibi-oids, 349 

" " in flexions, 596 

u " dilator, Emmet's, . . .151 
u " Plate IX. 

" bath, 745 

Sphygmographs, 161 

Steps to be taken in making a vaginal 

examination, 21 

Strangury, 646 

" etiology, 646 

" diagnosis, 647 

" prognosis, 647 

" treatment, 648 

Stem pessaries, objections to, ... . 593 

Straight needle forceps, 526 

lithotomy forceps, . . Plate VIII. 

Stone in the bladder, 462 

" " " symptoms, 463 

" " " diagnosis, 464 

" " " treatment, 464 



IXDEX. 



779 



Page. 
Stone in the bladder, operation for, . 467 
" " " " after treatment, 470 

" " " remedies for, .... 470 
" " " removal by lithotrity, 465 
" « " " " lithectasy, 465 

Stenosis of the uterus, 452 

" " cervix uteri, . . 452, 256 

" " « " treatment, 453 

Sterility, 249 

" as a result of pelvic cellulitis, 120 

" diagnosis, 255, 358 

" treatment, 257 

Stomatitis materna, 747 

"' " etiology, .... 747 

" " symptoms, . . . 747 

" " diagnosis, .... 747 

" " treatment, . . . 748 

Suppression of the urine, 646 

" " menstruation, . . 268 

Sub-acute inflammation of the 

uterus, 62, 64 

Suppositories, uterine, medicated, 713, 229 

Suspended animation 756 

Suture needles, . Plate XII!. 

Supports of the uterus, 559. 

Supporters, abdominal, . 156, 157, 557, 558 
.... Plate XII. 

" Eaton's. 157 

. . Plate XII. 
« Old London, . . . 158 
Plate XII. 
" Silk elastic, .... 158 
Plate XII. 
" Babcock's uterine, 149 
" M'Intosh's " 150 

Sub-acute ovaritis, 266 

Subserous fibroids of the uterus, .* . . 343 

Submucous " " li . . . 343 

Sub-involution of the uterus, 219, 709, 710 

'• " " " symptoms, . 710 

t; " " " etiology, . .711 

" " " « results . . 709 

" " " " treatment, . 712 

Success of iodine injections in ovarian 

cystoma, 304 

Swing bed, 338 

Symptoms of uterine disease, .... 21 

Syphilis in women, 655 

" secondary, 655 

" tertiary, 655 



Page. 

Syphilis, how contracted, 655 

" symptoms and diagnosis, . . 657 

" treatment, 658 

Syphilitic ulceration of the vagina, . 629 
Syringe for injecting fibroids, . . . .171 

Sympathetic affections, 472, 487 

" 4i treatment, 477, 486 

" " electricity in, . 479 

TAPPING, 739, 743 

Tampon, vaginal, 350, 363 

Tenesmus, uterine, 220 

Tents,, spouge, 150, 230, 349, 365, 602, 713 

" sea-tangle, 230 

" cotton, 229 

Tenaculum, Bozeman's, . . . Plate XIII. 

Tetanus, 759 

Thomas" clamp, Plate XV. 

Thrombus, 490, 716, 722, 726 

Tiemann & Co.'s aspirator, . . Plate IX. 
Tolerance cf the system to abnormal 

conditions, 479 

Trocar, Spencer Wells', 320 

" long curved, 125 

" " " uterine, .... 710 

Treatment of acute metritis, .... 80 

Tri-valve speculum, Plate IV. 

Treatment of ovarian cysts with iodine 

injections, 304 

" uterine fibroids (submucous) 

with sponge tents, . . . 349 
" palliative of uterine polypi, 349 

Triturations of remedies, 138 

Transmissibility of syphlnlis, .... 655 

Tumors of the breast, 697 

" " " non-malignant, 699 

« malignant, 692, 700 

" " cancerous, 692. 700 

u " " fatty, 700 

" labia, 726 

" " uterus, 352 

" " fibrous, .... 343 

" polypoid, . . . 352 

" " vagina, 406, 417 

" ovarian, 275 

Tubal gestation, . 440,643 

" " pregnancy, . . . 440, 043 

" " operation, 443 

Tubes, Fallopian, diseases of, .... 439 
" " cancer of, . . . . . 443 



780 



INDEX. 



Pagic. 
Tabes, Fallopian, displacements of, . 443 

Tuberculosis of the uterus, 403 

" " vagina, 451 

" " Fallopian tubes, . 443 

Tuberculous ulceration of vagina, . . 629 

Tumor forceps, Plate XT. 

Tympanites, 487 

ULCERATION of the vagina, . . . .629 
u ' " " cancerous, . 629 

" " syphilitic, . 629 
" " urethra, .... 449 

" " os uteri, . . . .179 

" " cervix uteri, . . 179 

" " " " causes of, 180 

" " " " diagnosis, 183 

" " treatment, 185 

Urine, suppression of, 646 

" retention of, 646 

Urethritis, 445 

Urethro-vaginal fistula, 511 

Ureto-vnginal fistula, 511 

Ureemia, 284, 662 

Urethra, diseases of, 445 

" inflammation of, 445 

" prolapse of, 445 

" ulceration of, 445 

" fissure of, 445 

" caruncles of, 445 

■' polypi of, 445 

Urinary calculi, 462 

" " caused from spinal injury, 462 
Urethral speculum bi-valve, .... 446 
Uterus, inflammation of, .... 77, 126 

" neuralgia of, 736 

" stenosis of, 452 

" " treatment, ...... 453 

" catarrh of, • 380 

" " « etiology, 381 

» " " dingnosis, ..... 381 

" " "* treatment, 383 

" cancer of, 167, 400 

" malformation, 750, 754 

" tuberculosis of, 403 

" abscess in, 241 

" sub-involution of, 219,709 

<< " " " symptoms, . . 710 

<i " « " etiology, . . .711 

» « " » effects of, . . 709 

" « « " treatment, . . 712 



Page. 
Uterus, hypertrophy of, . . 162, 219, 709 

" bilocularis, 755 

" irritable, 93, 736 

" hyper-involution of, . 255, 259, 750 

" hydatids of, 356 

" hydatids of, treatment, .... 372 

" supports of, 539 

" normal position of, 554 

" Plates II and III. 

" inversion of, 563 

" " " " etiology, 565 

" " " " diagnosis, 567 

" " " " treatment, 569 

" " " " " of chronic cases, 571 

" " of operation for, 572 

tl " " Simpson's operation for, 575 

" " Thomas' " " 575 

" " " Barnes' " " 575 

" " " Watts' " " 575 

" " White's " « 573 

" " " treatmentby amputation, 576 

" " " spontaneous reduction, . 576 

" " " anomalous cases of, . . 577 

" displacements of, 552, 663 

' ; " " symptoms, . . 561 

" " " etiology, . . . 561 

" " " treatment, . . 562 

" extirpation of, 727, 346 

" " " experience in, . . 729 

" ablation of, 727 

' : " " cases of, . . . . . . 729 

" prolapse of, 563, 605 

" " " treatment, 615 

" procidentia of, 563, 605 

" " '' treatment, . . . 615 

« retro-flexion of, 563, 605 

" " " " etiology, .... 579 

" " " " diagnosis, . . . 581 

" " " " treatment, . . . 587 

" retro-version of, . . . 563, 578, 663 

" ll l - " etiology, .... 579 

" " " " diagnosis, . . . 581 

" " " " treatment, . . . 587 

« lateral flexions, 563, 603 

" ante-version of, 563, 598 

« " " " etiology and diagnosis, 599 

" < l " " treatment, 600 

" ante-flexion of, 563, 598 

" " " li etiology and diagnosis, 599 

« « " " treatment, 600 



INDEX. 



781 



Uterus, elevation of, 



Page. 
.... 563, 775 
" .... Plate XXVIII. 

" papillary tumors of, 395 

" carcinoma of, 292, 400 

" fibro-cyst of, 302 

" tumors of, . . . . 292, 302, 342, 352 

" polypi of, 352 

'• scirrhus of, 400 

" encephaloid of, 400 

" sarcoma of, 400 

" cauliflower excrescence of, . . . 400 

« hemorrhage from, 201, 222, 254, 500 

Uterine organs, front view, . . . Plate I. 

4! " side view, . . . Plate II. 

" trocar, 510 

" electrode, 714 

" applicators, 715 

44 repositor, White's, 573 

" dressing forceps, 184 

.... Plate V. 

" sounds, 22 

" " Plate V. 

" diseases, symptoms of, ... . 21 

" dilator, 146 

Plate VIII. 

" elevator, Plate XIV. 

44 " Sims : , 159 

"... Plate XIV. 

14 Elliott's, 159 

4(41 . . Plate XIV. 

44 tenesmus, 220 

44 colic, 586 

" myoma, 342 

44 fibroids, 302 

'• stem pessary objectionable, . 593 
" cervix, lacerations of, ... . 539 
4 ' injections, caution against, . . 216 

44 polypi, 352 

« " etiology, 354 

" " morbid anatomy, . . . 354 

" 4l diagnosis, 357 

" li differential diagnosis, . 360 

44 treatment, 363 

" " sponge tents in treatm't, 349 

" " operation for removal of, 364 

44 hydatids, 352, 356 

44 moles, 375 

il " causes of, 376 

" " treatment, 376 

fibroma, . . . 342 



Page. 
Uterine fibroids treated by ergotine 

injections, ........ 348 

fibro-cyst, 291 

44 polypi, vascular, 352 

" " « treatment of, . . 372 

" " mucous, 352 

44 " " treatment, . . .372 

44 hemorrhage, . . 201, 222, 254, 500 

VAGINAL examination, 22 

washes, . . 233, 603, 744, 746 

44 ovariotomy, 335 

pessaries, . 148, 236, 593, 603 

fistula?, 511 

44 simple, 537 

blind, 537 

44 4 ' other varieties, . . 537 

Vaginitis, 186,219,254 

44 treatment of, 189 

44 remedies in, 192 

diphtheritic, 194 

Vagina, inflammation of, 186 

cysts of, 406, 414 

44 4 ' " pathol. anat,, .... 414 

44 44 " etiology, 414 

' 4 44 44 symptoms, 415 

" 4 ' " diagnosis, 415 

44 « " treatment, 415 

fibroids of, 406, 417 

4t polypi of, 406, 417 

catarrh of the, 186, 380 

prolapse of, 389, 406 

" hernia of, 404 

44 atresia of, 502 

" 4 ' 44 operation foi% . . 507 

" lacerations of, 629 

" cancerous ulceration of, . . . 629 
44 syphilitic 44 " 629, 655 

" tuberculosis of, 451 

44 fissures of, 630 

" fistula of, 511 

Vaginal tampons, 350, 363 

Vascular polypi of the uterus, . 352, 372 
Varieties of uterine fibroids, .... 343 

Vaginismus, 162, 172, 254 

" symptoms, 174 

44 etiology, 175 

" treatment, 176 

Vegetations of the endometrium, 352. 353 
44 '< 355 



782 



INDEX. 



Page. 

Venery, excessive, a cause of sterility, 255 

Vesicovaginal fistula, 511, 520 

<■'• " " operations for, . 523 

Vesico-cervical fistula, 511,531 

Vesico-uterine fistula, ....... 531 

Yesico-vaginal fistula, artificial, for 
relief of chronic cystitis, 458 

Virgin os uteri, 26 

" examination of, ...... 24 

Vicarious menstruation, . . .34, 56, 498 
" " treatment of, . 58 

Vomiting in pregnancy, .... 668, 672 
•« " " diagnosis, . . 674 

" " " treatment, . . 674 

{< after ovariotomy, 333 

" " " treatment, . 334 

Vulvae, pruritus of, . . 406, 409, 664, 670 
" neuromata of, 739 

Vulsellum forceps, Plate X. 

WASHES, vaginal, 233, 603 

Weed in the breast, 695 

Wells' clamps, 160 

" Plate XV. 



Page. 

White's hysterotome, 145 

" hysterotome, Plate V. 

" treatment of inversion, . . . 573 
Watts' • " " « ... 575 

Whites (leucorrhoea), 240 

Wire holder and twister, Eaton's, . -146 
" " " « « Plate VI. 

Wocher's bi-valve speculum 143 

. . Plate IV. 

Womb, inflammation of, 77, 126 

" " " chronic, . . 62, 70 

" tumors of, 343 

" symptoms of disease of, . . . 31 
<c (see Uterus.) 

YOUNG GIRLS, gonorrhoea in, . . . 653 

" " vaginitis in, 191 

'« " " treatment of, . . 191 
" " menstruation in, ... . 31 
iC " atresia of cervix uteri in, 505 
" " time and symptoms of pu- 
berty in, 494 

" " treatment of diseases pe- 
culiar to, 498 



FINIS. 



BOERICKE & TAFEL'S 

HOMCEOPATHIC PUBLICATIONS. 



ALLEN, DR. T. F. The Encyclopedia of Pure Materia Medica ; 
a Record of the Positive Effects of Drugs upon the Healthy- 
Human Organism. With contributions from Dr. Kichard Hughes, of 
England ; Dr. C. Hering, of Philadelphia ; Dr. Carroll Dunham, of New- 
York ; Dr. Adolph Lippe, of Philadelphia, and others. X volumes. Price 
bound in cloth, $60.00 ; in half morocco or sheep, . . . $70 00 
This is the most complete and extensive work on Materia Medica ever 
attempted in the history of medicine — a work to which the homoeopathic 
practitioner may turn with the certainty of finding the whole pathogenetic 
record of any remedy ever used in homoeopathy, the record of which being 
published either in bookform or in journals. The volumes average about 
640 pages each. The work is now completed, and an index or symptom 
register to the Encyclopedia will be issued within a short time. 

ALLEN AND NORTON. Ophthalmic Therapeutics, by Timothy 
F. Allen, M.D., Surgeon to the New York Ophthalmic Hospital, Professor 
of Materia Medica and Therapeutics in the New York Homoeopathic 
Medical College, and Geo. S. Norton, M.D., Surgeon to the New York 
Ophthalmic Hospital, and Ophthalmic and Aural Surgeon to the Homoeo- 
pathic Hospital on Ward's Island. 269 pages, 8vo. Cloth, . . $2.00 

. . . "This work contrasts favorably with many similar treatises. It has not been 
written by inexperienced practitioners, but of men who write of that which they have seen — 
of that which they have accomplished. ... It is, in short, a useful book, and as such 
we commend it to the study of our readers." — Monthly Horn. Review. 

ANGELL, DR. H. 0. A Treatise on Diseases of the Eye; for the 
Use of Students and Practitioners. By Henry C. Angell, M.D., 
Professor of Ophthalmology in the Boston University School of Medicine, 
etc., etc. Fifth edition, enlarged and illustrated. 343 pages. 12mo. 
Cloth, $3 00 

The fifth edition of this standard work has just been issued from the press, and shows that 
the whole work has been thoroughly revised and brought up to the latest dates in ophthal- 
mology. Exquisite clear photographic illustrations have been added, and an exposition given 
of the dioptric or metric system, as applied to lenses for spectacles. 

BAEHR, DR. B. The Science of Therapeutics according to the 

Principles of Homoeopathy. Translated and enriched with numerous 

additions from Kafka and other sources, by C. J. Hempel, M.D. Two 

volumes. 1387 pages, $9 00 

. . . " In short Dr. Baehr has presented us with the results of his observations at 
the bedside rather than of his researches in the study. It is this which renders his work 
valuable and which at the same time accounts for his occasional imperfections. We know 



of no work of the kind in homoeopathic literature where the suggestions for the choice of 
medicines are given in a fresher or clearer manner, or in one better calculated to interest 
and inform the practitioner. We have only to add that the two volumes are highly credit- 
able to the publishers. The type is good, the paper good, and the binding excellent." — 
Monthly Homoeopathic Review. 

BECKER, DR. A. C. Dentition, according to some of the best 
and latest German authorities. 82 pages. i2mo. Cloth, . 50 cts. 

BECKER, DR. A. C. Diseases of the Eye, treated homceopathi- 
cally. From the German. 77 pages. l2mo. Cloth, . . 50 cts. 

BELL, DR. JAMES B, The Homoeopathic Therapeutics of 
Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera In- 
fantum, and all other loose evacuations of the bowels. 168 
pages. Bound in Muslin. 12mo. Cloth, $1 00 

This little book had a very large sale, and but few physicians' offices will be found with- 
out it. The work was, without exception, very highly commended by the homoeopathic 
press. 

BERJEAU, J. PH. The Homoeopathic Treatment of Syphilis, 

Gonorrhoea, Spermatorrhoea, and Urinary Diseases. Revised, 

with numerous additions, by J. H. P. Frost, M.D. 256 pages. 12mo. 

Cloth, $1 50 

" This work is unmistakably the production of a practical man. It is short, pithy, and 
contains a vast deal of sound practical instruction. The diseases are briefly described ; the 
directions for treatment are succinct and summary. It is a book which might with profit 
be consulted by all practitioners of homoeopathy." — North American Journal. 

BREYFOGLE, DR. W. L. Epitome of Homoeopathic Medi- 
cines. 383 pages, $1 25 

Interleaved with writing paper. Half morocco, . . . . $2 25 
We quote from the author's preface : 

" It has been my aim, throughout, to arrange in as concise form as possible, the leading 
symptoms of all well-established provings. To accomplish this, I have compared Lippe's 
Mat. Med.; the Symptomen-Codex ; Jahr's Epitome; Boenninghausen's Therapeutic Pocket- 
Book, and Hale's New Kemedies." 

BRYANT, DR. J. A Pocket Manual, or Repertory of Homoeo- 
pathic Medicine, Alphabetically and Nosological ly arranged, which 
may be used as the Physicians' Vade-mecum., the Travellers' Medical Com- 
panion, or the Family Physician. Containing the Principal Eemedies 
for the most important Diseases ; Symptoms, Sensations, Characteristics 
of Diseases, etc.; with the Principal Pathogenetic Effects of the Medi- 
cines on the most important Organs and Functions of the Body, together 
with Diagnosis, Explanation of Technical Terms, Directions for the selec- 
tion and Exhibition of Remedies, Rules of Diet, etc. Compiled from 
the best Homoeopathic authorities. Third edition. 352 pages. 18mo. 
Cloth, • • ... . . $1 50 

BUTLER, JOHN. A Text-Book of Electro-Therapeutics and 
Electro-Surgery, for the Use of Students and General Prac- 
titioners. By John Butler, M.D., L.R.C.P.E., L.R.C.S.I., etc., etc. 
Second edition, revised and enlarged. 350 pages. 8vo. Cloth, $3 00 
" Butler's work gives with exceptional thoroughness all details of the latest researches od 



HOMOEOPATHIC PUBLICATIONS. 



Electricity, which powerful agent has a great future, and rightly demands our most earnest 
consideration. But Homceopathia especially must hail with delight the advent from out 
the ranks of her apostles of a writer of John Butler's ability. His book will also find a 
large circle of non-homceopathic readers, since it does not conflict with the tenets of any 
therapeutic sect, and particular care has been bestowed on the technical part of electro- 
therapeia." — Homceopathische Rundschau. 

DAKE, DR. WM. C. Pathology and Treatment of Diphtheria. 
By Wm. C. Dake, M.D., of Nashville, Tenn. 55 pages. 8vo. Paper, 50 cts. 

This interesting monograph was enlarged from a paper read at the Third 
Annual Meeting of the Homoeopathic Society of Tennessee, held at Mem- 
phis, September 19, 1877. 

It gives a report of one hundred and seventy-six cases treated during a 
period of eleven months. It well repays a careful perusal. 

DUNHAM, CARROLL, A.M., M.D. Homoeopathy the Science 

of Therapeutics. A collection of papers elucidating and illustrating 

the principles of homoeopathy. 529 pages. 8vo. Cloth, . . $3 00 

Half morocco, $4 00 

"After reading this work no one will attempt to justify the practice of alternation of 
remedies. It is simply the lazy man's expedient to escape close thinking or to cover his 
ignorance. The one remedy alone can be accurate and scientific ; a second or third only 
complicates and spoils the case, and will inevitably ruin a good reputation. But to come to 
more practical matters, more than one-half of this volume is devoted to a careful analysis of 
various drug-provings. It teaches us Materia Medica after a new fashion, so that a fool can 
understand, not only the full measure of usefulness, but also the limitations which surround 
the drug. . . . We ought to give an illustration of his method of analysis, but space 
forbids. Wc can only urge the thoughtful and studious to obtain the book, which they will 
esteem as second only to the Organon in its philosophy and learning." — The American 
Homceopathist. 

DUNHAM, CARROLL, A.M., M.D. Lectures on Materia Medica. 

858 pages. 8vo. Cloth, $5 00 

Half morocco, . . . . . # $6 00 

. . . " Vol. I is adorned with a most perfect likeness of Dr. Dunham, upon which 
stranger and friend will gaze with pleasure. To one skilled in the science of physiognomy 
there will be seen the unmistakable impress of the great soul that looked so long and stead- 
fastly out of its fair windows. But our readers will be chiefly concerned with the contents 
of these two books. They are even better than their embellishments. They are chiefly 
such lectures on Materia Medica as Dr. Dunham alone knew how to write. They are pre- 
ceded quite naturally by introductory lectures, which he was accustomed to deliver to his 
classes on general therapeutics, on rules which should guide us in studying drugs, and on 
the therapeutic law. At the close of Vol. II we have several papers of great interest, but 
the most important fact of all is that we have here over fifty of our leading remedies pre- 
sented in a method which belonged peculiarly to the author, as one of the most successful 
teachers our school has yet produced. . . . Blessed will be the library they adorn, and 
wise the man or woman into whose mind their light shall shine." — Cincinnati Medical Ad- 
vance. 

EGGrERT, DR. W. The Homoeopathic Therapeutics of Uterine 
and Vaginal Discharges. 543 pages. 8vo. Half morocco, $3 50 
The author brought here together in an admirable and comprehensive 
arrangement everything published to date on the subject in the whole 
homoeopathic literature, besides embodying his own abundant personal ex- 
perience. The contents, divided into eight parts, are arranged as follows : 
Part I. Treats on Menstruation and Dysmenorrhea; Part II. Menor- 
rhagia; Part III. Amenorrhoea; Part IY. Abortion and Miscarriage ; Part V. 



Metrorrhagia ; Part YI. Fluor albus ; Part VII. Lochia / and Part VIII. 

General Concomitants. No work as complete as this, on the subject, was 
ever before attempted, and We feel assured that it will meet with great 
favor by the profession. 

" The book is a counterpart of Bell on Diarrhoea, and Dunham on Whooping-cough. 
Synthetics, Diagnosis and Pathology are left out as not coming within the scope of the work; 
The author in his preface says : Eemedies and their symptoms are left out, and the symp- 
toms and their remedies have received sole attention — that is what the busy practitioner 
wants. The work is one of the essentials in a library." — American Observer. 

" A most exhaustive treatise, admirably arranged, covering all that is known of therapeu- 
tics in this important department." — Homoeopathic Times. 

GUERNSEY, DR. H. N. The Application of the Principles and 
Practice of Homoeopathy to Obstetrics and the Disorders Pe- 
culiar to Women and Young Children. By Henry N. Guernsey. 
M.D., Professor of Obstetrics and Diseases of Women and Children in the 
Homoeopathic Medical College of Pennsylvania, etc., etc. With numerous 
Illustrations. Third edition, revised, enlarged, and greatly improved. 
1004 pages. 8vo. Half morocco, $8 00 

This standard work, with the numerous improvements and additions, is the most com- 
plete and comprehensible work on the subject in the English language. Of the previous 
editions, almost four thousand copies are in the hands of the profession, and of this third 
edition 'a goodly number have already been taken up. There are few other professional 
works that can boast of a like popularity, and with all new improvements and experiences 
diligently collected and faithfully incorporated into each successive edition, this favorite 
work will retain its hold on the high esteem it is held in by the profession, for years to come. 
It is superfluous to add that it was and is used from its first appearance as a text-book at the 
homoeopathic colleges. 

GUERNSEY, DR. E. Homoeopathic Domestic Practice. With 
Full Descriptions to the Dose to each single Case. Containing also 
Chapters on Anatomy, Physiology, Hygiene, and an abridged Materia 
Medica. Tenth enlarged, revised, and improved edition. 653 pages. 
Half leather, $2 50 

GUERNSEY, DR. W. E. The Traveller's Medical Repertory and 
Family Adviser for the Homoeopathic Treatment of Acute 
Diseases. 36 pages. Cloth, 30 cts. 

This little work has been arranged with a view to represent in as compact a manner as 
possible all the diseases— or rather disorders— which the non-professional would attempt to 
prescribe for, it being intended only for the treatment of simple or acute diseases, or to allay 
the suffering' in maladies of a more serious nature until a homoeopathic practitioner can be 

summoned. 

HAHNEMANN, DR. S. The Lesser Writings of. Collected and 
Translated by E. E. Dudgeon, M.D. With a Preface and Notes by E. 
Marcy, M.D. With a Steel Engraving of Hahnemann from the statue 
of Steinhauser. 784 pages. Half bound, . . . . . $3 00 

This valuable work contains a large number of Essays, of greaHnterest to laymen as well 
as medical men, upon Diet, the Prevention of Diseases, Ventilation of Dwellings, etc. As 
many of these papers were written before the discovery of the homoeopathic theory of cure, 
the reader will be enabled te peruse in this volume the ideas of a gigantic intellect when di- 
rected to subjects of general and practical interest. 



HOMOEOPATHIC PUBLICATIONS. 



HAHNEMANN, DR. S. Organon of the Art of Healing. By 
Samuel Hahnemann. Ancle Sapere. Fifth American edition, translated 
from the Fifth German edition, by C. Wesselhceft, M.D. 244 pages. 
8vo. Cloth, . . . • $1 75 

This fifth edition of " Hahnemann Organon " has a history. So many 
complaints were made again and again of the incorrectness and cumber- 
some style of former and existing editions to the publishers, that, yielding 
to the pressure, they promised to destroy the plates of the fourth edition, 
and to bring out an entire re-translation in 1876, the Centennial year. After 
due consideration, and on the warm recommendation of Dr. Constantine 
Hering and others, the task of making this re-translation was confided to 
Dr. C. Wesselhceft, and the result of years of labor is now before the pro- 
fession, who will be best able themselves to judge how well he succeeded 
in acquitting himself of the difficult task. 

" To insure a correct rendition of the text of the author, they (the publishers) selected as 
his translator Dr. Conrad Wesselhoeft, of Boston, an educated physician in every respect, 
and from his youth up perfectly familiar with the English and German languages, than 
whom no better selection could have been made." " That he has made, as he himself de- 
clares, ' an entirely new and independent translation of the whole work,' a careful compari- 
son of the various paragraphs, notes, etc., with those contained in previous editions, gives 
abundant evidence ; and while he has, so far as was possible, adhered strictly to the letter of 
Hahnemann's text, he has at the same time given a pleasantly flowing rendition that avoids 
the harshness of a strictly literal translation." — Hahnemannian Monthly. 

HALE, DR. E. M. Lectures on Diseases of the Heart. In Three 
Parts. Part I. Functional Disorders of the Heart. Part II. Inflamma- 
tory Affections of the Heart. Part III. Organic Diseases of the Heart. 
Second enlarged edition printing. 

HALE, DR. E. M. Materia Medica and Special Therapeutics of 

the New Remedies. Fourth edition, revised and enlarged. In two 

Volumes. 

Vol. I. Special Symptomatology. With new Botanical and Pharmaco- 
logical Notes. 672 pages. Cloth, $5 00 

Vol. II. Special Therapeutics. With Illustrative Clinical Cases. 900 
pages. Second enlarged edition. Cloth, .... $5 00 

!N\ B. — Same in half morocco, per Volume, .... $6 00 

" Dr. Hale's work on New Remedies is one both well known and much appreciated on this 
side of the Atlantic. For many medicines of considerable value we are indebted to his re- 
searches. In the present edition, the symptoms produced by the drug investigated, and 
those which they have been observed to cure, are separated from the clinical observations, 
by which the former have been confirmed. That this volume contains a very large amount 
of invaluable information is incontestable, and that every effort has been made to secure 
both fulness of detail and accuracy of statement, is apparent throughout. For these reasons 
we can confidently commend Dr. Hale's fourth edition of his well-known work on the New 
Remedies to our homoeopathic colleagues." — Monthly Homoeopathic Review. 

" We do not hesitate to say that by these publications Dr. Hale rendered an inestimable 
service to homoeopathy, and thereby to the art of medicine. l The school of Hahnemann in 
every country owes him hearty thanks for all this ; and allopathy is beginning to share our 
gain.' The author is given credit for having in this fourth edition corrected the mistake 
for which the third one had been taxed rather severely, by restoring in Vol. II the ' special 
therapeutics,' instead of the 'characteristics' of the third edition." — British Journal of Ho~ 
mceopathy. 



BOERICKE & TAFEL'S 



HALE, DR. E. M. The Medical, Surgical, and Hygienic Treat- 
ment of Diseases of Women, especially those causing Sterility, 
the Disorders and Accidents of Pregnancy, and Painful and 
Difficult Labor. By Edwin M. Hale, M.D., Professor of Materia 
Medica and Therapeutics in the Chicago Homoeopathic College, etc., etc. 
Second enlarged edition. 378 pages. 8vo. Cloth, . . . $2 50 

" This new work embodies the observations and experience of the author during twenty-five 
years of active and extensive practice, and is designed to supplement rather than supersede 
kindred works. The arrangement of the subjects treated is methodical and convenient ; the 
introduction containing an article inserted by permission of Dr. Jackson, of Chicago, the 
author upon the ovular and ovulation theory of menstruation, which contains all the obser- 
vations of practical importance known on this subject to date. The diseases causing sterility 
are fully described, and the medical, surgical, and hygienic treatment pointed out. The 
more generally employed medicines are enumerated, but their special or specific indications 
are unfortunately omitted. The general practitioner will find a great many valuable things 
for his daily rounds, and cannot afford to do without the book. The great reputation and 
ability of the author are sufficient to recommend the work, and to guarantee an appreciative 
reception and large sale." — Hahnemannian Monthly. 

HAYWARD, DR. JOHN W. Taking Gold (the Cause of half 
our Diseases) : Its Nature, Causes, Prevention and Cure ; its 
frequency as a Cause of other Disease, and the Diseases of 
which it is the Cause, with their Diagnosis and Treatment. 

Fifth edition, enlarged and improved. London, 1875. 188 pages. 18mo. 

Cloth, 50 Cts. 

Wc quote from the author's preface : 

" This Essay was originally published under the conviction that, by attention to the di- 
rections it contains, persons may not only very frequently avoid taking cold, but may them- 
selves frequently cure a cold at the onset, and thereby prevent the development of many of 
those serious diseases that would otherwise follow. The favorable reception it has met with 
is a sufficient testimony that it has been found useful." 

HELMUTH, DR. W. T. A System of Surgery. Illustrated with 
568 Engravings on Wood. By ¥m, Tod Helmuth, M.D. Third edition. 
1000 pages. Sheep, $8 50 

This third edition of Dr. Helmuth's great work is already in appearance a great improve- 
ment over the old edition, it being well printed on fine paper, and well bound. By increas- 
ing the size of the page, decreasing the size of type, and setting up solid, fully one-half more 
printed matter is given than in the previous edition, albeit there are over 200 pages less. 
And while the old edition, bound in sheep, was sold at $11.50 by its publishers, this im- 
proved third edition is now furnished at $3 less, or for $8.50. The author brought the work 
fully up to date, and for an enumeration of some of the more important improvements, we 
cannot do better than to refer to Dr. Helmuth's own Preface. 

HEMPEL, DR. O. J. The Science of Homoeopathy ; or, A Critical 
and Synthetical Index of the Doctrines of the Homoeopathic School. 
Second edition. 180 pages. Large 8vo. Cloth, . . . $1 75 

HEMPEL, DR. O. H. Complete Repertory of the Homoeopathic 
Materia Medica. 1224 pages, . . . , . . $6 OO 

The object of this work is simply to make the finding of any symptom or group of symp- 
toms, which a physician may be called upon to treat, a matter of perfect certainty ; provided 
always such may exist among the results of our physiological provings. The classification 
of the symptoms which has been adopted is more complete, and at the same time more 
simple and practical, than anything of the kind ever published in our language. 



HOMCEOPATHlC PUBLICATIONS. 



HEMPEL, DR. 0. J., and DR. J. BEAKLEY. Homoeopathic 
Theory and Practice. With the Homoeopathic Treatment of Surgi- 
cal Diseases, designed for Students and Practitioners of Medicine, and 
as a Guide for an intelligent public generally. Fourth edition. 1100 
pages, $3 00 

HERINGr, DR. 0. Condensed Materia Medica. Second edition. 
More condensed, revised, enlarged, and improved, . . . $7 00 

In February, 1877, we were able to announce the completion of Bering's Condensed Ma- 
teria Medica. The work, as was to be expected, was bought up with avidity by the profes- 
sion, and already in the Fall of 1878 the author set to work perfecting a second and im- 
proved edition. By still more condensing many of the remedies, a number of new ones 
could be added without much increasing the size and the price of the work. This new 
edition is now ready for the profession, and will be the standard work par excellence for the 
practitioner's daily reference. 

HILDEBRANDT, PROP. H. Catarrh of the Female Sexual 
Organs. Translated, with the addition of the Homoeopathic Treatment, 
by S. Lilienthal, M.D., 30 cts. 

HITCHMAN, DR. W. Consumption; Its Nature, Prevention, 
and Homoeopathic Treatment. With Illustrations of Homoeopathic 
Practice. 184 pages, 60 cts. 

HOLCOMBE, DR. W. H. Yellow Fever and its Homoeopathic 
Treatment, 10 cts. 

HOLCOMBE, DR. W. H. What is Homoeopathy? A new expo- 
sition of great truth. 28 pages. 8vo. Paper cover, per doz., $1.25, 15 cts. 

"Prove all things, hold fast that which is good." — St. Paul. 

HOLCOMBE, DR. W. H. How I became a Homoeopath. 28 
pages. 8vo. Paper cover, per dozen, $1.25, . . . .15 cts. 

HOLCOMBE, DR. W. H. Special Report of the Homoeopathic 
Yellow Fever Commission, ordered by the American Institute of 
Homoeopathy for presentation to Congress. 32 pages. 8vo. Paper, 
per 100, $4.00, " 5 cts. 

This "Report, written in Dr. Holcombe's masterly manner, is one of the best campaign 
documents for homoeopathy. The statistics must convince the most skeptical, and every 
homoeopathic practitioner should feel in duty bound to aid in securing its widest possible 
circulation. 

HOMCEOPATHIC POULTRY PHYSICIAN (Poultry Veterina- 
rian) ; or, Plain Directions for the Homoeopathic Treatment of the most 
Common Ailments of Fowls, Ducks, Geese, Turkeys, and Pigeons, based 
on the author's large experience, and compiled from the most reliable 
sources, by Dr. Fr. Schroter. Translated from the German. 84 pages. 
12mo. Cloth, 50 Cts. 

"We imported hundreds of copies of this work in the original German for our customers, 
and as it gave good satisfaction, we thought it advisable to give it an English dress, so as to 
make it available to the public generally. The little work sells very fast, and our readers 
will doubtless often have an opportunity to draw the attention of their patrons to it. 



BOERICKE & TAFEL S 



HOMOEOPATHIC COOKERY. Second edition. With additions by 
a Lady of an American Homoeopathic Physician. Designed chiefly for 
the Use of such Persons as are under Homoeopathic Treatment. 176 
pages, . . . 50 cts. 

HUGHES, DR. R. Manual of Pharmacodynamics. 500 pages. 
American reprint out of print. See list of British books. 

HUGHES, DR. R. Manual of Therapeutics. 540 pages. American 
reprint out of print. See list of British books. 

HULL'S JAHR. A New Manual of Homoeopathic Practice, 

Edited, with Annotations and Additions, by F. Gr. Snelling, M.D. Sixth 

American edition. With an Appendix of the New Eemedies, by C. J. 

Hempel, M.D. 2 vols. 2076 pages, $9 00 

The first volume, containing the symptomatology, gives the complete pathogenesis of two 
hundred and eighty-seven remedies, besides a large number of new remedies are added by 
Dr. Hempel, in the appendix. The second volume contains an admirably arranged Eeper- 
tory. Each chapter is accompanied by copious clinical remarks and the concomitant symp- 
toms of the chief remedies for the malady treated of, thus imparting a mass of information, 
rendering the work indispensable to every student and practitioner of medicine. 

JAHR, DR. Q. H. G. Therapeutic Guide ; the most Important Ke- 

sults of more than Forty Years' Practice. With Personal Observations 

regarding the truly reliable and practically verified Curative Indications 

in actual cases of disease. Translated, with Notes and New Eemedies, 

by C. J. Hempel, M.D. 546 pages, $3 00 

"With this characteristically long title, the veteran and indefatigable Jahr gives us 
another volume of homoeopathies. Besides the explanation of its purport contained in the 
title itself, the author's preface still further sets forth its distinctive aim. It is intended, he 
says, as a ' guide to beginners, where I only indicate the most important and decisive points 
for the selection of a remedy, and where I do not offer anything but what my own individual 
experience, during a practice of forty years, has enabled me to verify as absolutely decisive in 
choosing the proper remedy.' The reader will easily comprehend that, in carrying out this 
plan, I had rigidly to exclude all cases concerning which I had no experience of my own to 

offer We are bound to say that the book itself is agreeable, chatty, and full of 

practical observation. It may be read straight through with interest, and referred to in the 
treatment of particular cases with advantage." — British Journal of Homoeopathy. 

JAHR, DR. G. H. G. Clinical Guide, or Pocket Repertory for 
the Treatment of Acute and Chronic Diseases.. Translated by 
C. J. Hempel, M.D. Second American revised and enlarged edition. 
From the third German edition, enriched by the addition of the New 
Eemedies. By S. Lilienthal, M.D. 624 pages. 12mo. Half mo- 
rocco, $2 50 

' To those of our readers who have used the old edition, nothing need be said to induce 
them to procure a copy of the new. To others, however, we feel free to state that as a 
volume of ready reference to lie on the office desk, or be used at the bedside, it is very valu- 
able, and will save many tedious and distracting hunts through the symptomen codex. The 
typographical execution of the book is excellent." — Hahnemannian Monthly. 

JAHR, DR. G-. H. G. The Homoeopathic Treatment of Diseases 

of Females and Infants at the Breast. Translated from the French 

by C. J. Hempel, M.D. 422 pages. Half leather, . . . $2 00 

This work deserves the most careful attention on the part of homoeopathic practitioners. 
The diseases to which the female organism is subject are described with the most minute 
correctness, and the treatment is likewise indicated with a care that would seem to defy 
criticism. No one can fail to study this work but with profit and pleasure. 



HOMOEOPATHIC PUBLICATIONS. 9 



JAHR, DR. G. H. Gc. Diseases of the Skin; or, Alphabetical Beper- 
toiy of the Skin Symptoms, and External Alterations of Substance, to- 
gether with the Morbid Phenomena observed in the Glandular, Osseous, 
Mucous, and Circulatory Symptoms. Arranged with Pathological Ee- 
marks on Diseases of the Skin. Edited by C. J. Hempel, M.D. 515 
pages. 12mo. Cloth, $1 50 

JAHR, DR. G. H. G. The Venereal Diseases, their Pathological 
Nature, Correct Diagnosis, and Homoeopathic Treatment. 
Prepared in accordance with the author's own, as well as with the expe- 
rience of other physicians, and accompanied with critical discussions. 
Translated, with numerous and important additions, from the works of 
other authors, and from his own experience. By C. J. Hempel, M.D, 
428 pages. 8vo. Cloth, $3 00 

This is the most elaborate treatise on the subject in print. The work is divided into four 
divisions, of which the first treats on Primary Forms of Venereal Diseases, in four chapters : 
On the Venereal Phenomena in general ; the Different Forms of Gonorrhoea ; the Various 
Forms of Chancre; and other Primary Forms of Syphilis. The second division, on Second- 
ary Forms of Syphilis, treats in three chapters, of Secondary Syphilis generally; Syphilitic 
Cutaneous Affections, and Intermediate Forms of Syphilis. The third division: General 
Pathological Observations on Syphilis and its course generally, in three chapters; Patho- 
logical Nature and Origin of Syphilis; on Venereal Contagia; General Development, 
Course, and Termination of Syphilis. The fourth division: General Therapeutic Observa- 
tions on the Treatment of Syphilis; General Diagnostic Remarks; General Therapeutic 
Observations ; Pharmaco-dynamic Observations, and Addenda. 

INDEX to the first eighteen volumes of the North American Journal of 
Homoeopathy. Paper, • . . $2 00 

JONES, DR. SAMUEL A. The Grounds of Homoeopathic Faith. 

Three Lectures, delivered at the request of Matriculates of the Depart- 
ment of Medicine and Surgery (Old School) of the University of Michi- 
gan. By Samuel A. Jones, M.D., Professor of Materia Medica, Thera- 
peutics, and Experimental Pathogenesy in the Homoeopathic Medical 
College of the University of Michigan, etc., etc. 92 pages. 12mo. Cloth, 
per dozen, $3 ; per hundred, $20, 30 cts, 

Lecture first is on The Law of Similars ; its Claim to be a Science in that it Enables Perver- 
sion. Lecture second, The Single Remedy a Necessity of Science. Lecture third, The Mini- 
mum Dose an Inevitable Sequence. A fourth Lecture, on The Dynamization Theory, was to 
have finished the course, but was prevented by the approach of final examinations, the prepa- 
ration for Avhich left no time for hearing evening lectures. The Lectures are issued in a con- 
venient size for the coat-pocket; and as an earnest testimony to the truth, we believe they 
will find their way into many a homoeopathic household. 

JOHNSON, DR. I. D. Therapeutic Key; or Practical Guide for the 

Homoeopathic Treatment of Acute Diseases. Third edition. 312 pages. 

Bound in linen, $1 50 

Bound in flexible cover, $2 00 

This has been one of the best selling works on our shelves ; more copies being in circula- 
t;on of this than of any two other professional works put together. It is safe to say that 
there are but few homoeopathic practitioners in this country but have one or more copies of 
this little remembrancer in their possession. 

JOHNSON, DR. I. D. A Guide to Homoeopathic Practice. De- 
signed for the use of Families and Private Individuals. 494 pages. 
Cloth, . r , $2 00 



10 BOERICKE & TAFEL'S 



This is the latest work on Domestic Practice issued, and the well and favorably known 
author has surpassed himself. In his book fifty-six remedies are introduced for internal ap- 
plication, and four for external use. The work consists of two parts. Part I is subdivided 
into seventeen chapters, each being devoted to a special part of the body, or to a peculiar 
class of disease. Part II contains a short and concise Materia Medica, i. e., gives the 
symptoms peculiar to each remedy. The whole is carefully written with a view of avoiding 
technical terms as much as possible, thus insuring its comprehension by any person of ordi- 
nary intelligence. A complete set of remedies in vials holding over fifty doses each, is fur- 
nished for $7, or in vials holding over one hundred doses each for $10, or book and case 
complete for $9 or $12 respectively. Address orders to Boericke & Tafel's Pharmacies at 
New York, Philadelphia, Baltimore, Chicago, New Orleans, or San Francisco. 

JOSLIN, DR. B. F. Principles of Homoeopathy. In a Series of 
Lectures. 185 pages. 12mo. Cloth, ..... 60 cts. 

JOSLIN, DR. B. P. Homoeopathic Treatment of Epidemic 
Cholera. Third edition, with additions. 252 pages. 12mo. Cloth, 

75 cts. 

This work offers the advantage of a threefold arrangement of the principal medicines, viz., 
with reference, I — to the varieties of cholera ; II — to its stages ; and III — to its symptoms as 
arranged in repertories. These last will give the work a permanent value in treating the 
more frequent complaints of summer. 

LAURIE AND McOLATOHEY. The Homoeopathic Domestic 
Medicine. By Joseph Laurie, M.D. Ninth American, from the Twenty- 
first English edition. Edited and revised, with numerous and important 
additions, and the introduction of the new remedies. By E. J. McClatchey, 
M.D. 1044 pages. ^ 8vo. Half morocco, $5 00 

" We do not hesitate to indorse the claims made by the publishers, that this is the most 
complete, clear, and comprehensive treatise on the domestic homoeopathic treatment of dis- 
eases extant. This handsome volume of nearly eleven hundred pages is divided into six 
parts. Fart one is introductory, and is almost faultless. It gives the most complete and 
exact directions for the maintenance of health, and of the method of investigating the con- 
dition of the sick, and of discriminating between different diseases. It is written in the 
most lucid style, and is above all things wonderfully free from technicalities. Part two treats 
of symptoms, character, distinctions, and treatment of general diseases, together with a chap- 
ter on casualties. Part three takes up diseases peculiar to women. Part four is devoted to 
the disorders of infancy and childhood. Part five gives the characteristic symptoms of the 
medicines referred to in the body of the work, while Part six introduces the repertory." — 
Hahnemannian Monthly. 

"Of the usefulness of this work in cases where no educated homoeopathic physician is 
within reach, there can be no question. There is no doubt that domestic homoeopathy has 
done much to make the science known ; it has also saved lives in emergencies. The prac- 
tice has never been so well presented to the public as in this excellent volume." — New Eng. 
Med. Gazette. 

A complete set of remedies of one hundred and four vials, containing over fifty doses each, 
is furnished for $12, put up in an elegant mahogany case. A similar set in vials containing 
over one hundred doses each, is furnished for $18, or book and case complete for $17 or $23 
respectively. Address orders to Boericke & Tafel's Pharmacies at New York, Philadelphia, 
Baltimore, Chicago, New Orleans, or San Francisco. 

LILIENTHAL, DR. S. Homoeopathic Therapeutics. By S. 

Lilienthal, M.D., Editor of North American Journal of Homoeopathy, 
Professor of Clinical Medicine and Psychology in the New York Homoeo- 
pathic Medical College, and Professor of Theory and Practice in the New 
York College Hospital for Women, etc. Second edition. 8vo, $5 00 
Half morocco, $6 00 

" Certainly no one in our ranks is so well qualified for this work as he who has done it, 
and in considering the work done, we must have a true conception of the proper sphere of 



HOMOEOPATHIC PUBLICATIONS. 11 



such a work. For the fresh graduate, this book will be invaluable, and to all such we un- 
hesitatingly and very earnestly commend it. To the older one, who says he has no use for 
this book, we have nothing to say. He is a good one to avoid when well, and to dread when 
ill. We also hope that he is severely an nnicumP — Prof. Sam. A. Jones in American Homoz- 



. It is an extraordinary useful book, and those who add it to their library will 
never feel regret, for we are not saying too much in pronouncing it the best work on therapeu- 
tics in homoeopathic for any other) literature. With this under one elbow, and Hering's or 
Allen's Materia Jledica under the other, the careful homoeopathic practitioner can refute 
Neimayer's too confident assertion, ' I declare it idle to hope for a time when a medical pre- 
scription should be the simple resultant of known quantities.' Doctor, by all means buy 
Lilienthal's Homoeopathic Therapeutics. It contains a mine of wealth." — Prof. Chas. Gatchel 
iii Ibid. 

LLLIENTHAL, DR. S. A Treatise on Diseases of the Skin. A 

new edition in preparation for the press. 

LUTZE, DR. A. Manual of Homoeopathic Theory and Practice. 

designed for the use of Physicians and Families. Translated 

from the German, with additions by C. J. Hempel, M.D. From the 

sixtieth thousand of the German edition. 750 pages. 8vo. Half 

leather, $2 50 

This work, from the pen of the late Dr. Lutze, has the largest circulation of any homoeo- 
pathic work in Germany, no less than sixty thousand copies having been sold. The intro- 
duction, occupying over fifty pages, contains the question of dose, and rules for examining 
the patient, and diet; the next sixty pages contain a condensed pathogenesis of the remedies 
treated of in the work ; the description and treatment of diseases occupy four hundred and 
eighteen pages, and the whole concludes with one hundred and seventy -three pages of reper- 
tory and a copious index, thus forming a concise and complete work on theory and practice. 

MALAN, H. Family Guide to the Administration of Homoeo- 
pathic Remedies. 112 pages. 32mo. Cloth, . . .30 cts. 

MANUAL OF HOMOEOPATHIC VETERINARY PRACTICE. 

Designed for all kinds of Domestic Animals and Fowls, prescribing their 

proper treatment when injured or diseased, and their particular care and 

general management in health. Second and enlarged edition. 684 pages. 

8vo. Half morocco, $5 00 

" In order to rightly estimate the value and comprehensiveness of this great work, the 
reader should compare it, as we have done, with the best of those already before the public. 
In size, fulness, and practical value it is head and shoulders above the very best of them, 
while in many most important disorders it is far superior to them altogether, containing, as 
it does, recent forms of disease of which they make no mention." — Hahnemannian Monthly. 

MARSDEN, DR. J. H. Handbook of Practical Midwifery, with 
full instructions for the Homoeopathic Treatment of the Dis- 
eases of Pregnancy, and the Accidents and Diseases incident 
to Labor and the Puerperal State. By J. H. Marsden, A.M., 3I.D. 
315 pages. Cloth, $2 25. 

" It is seldom we have perused a textbook with such entire satisfaction as this. The 
author has certainly succeeded in his design of furnishing the student and young practitioner 
within as narrow limits as possible, all necessary instruction in practical midwiferv. The 
work shows on every page extended research and thorough practical knowledge. The style 
is clear, the array of facts unique, and the deductions judicious and practical. We are par- 
ticularly pleased with his discussion of the management of labor, and the management of 
mother and child immediately after the birth, but much is left open to the common-sense 
and practical judgment of the attendant in peculiar and individual cases." — Homoeopathic 
Times. 



12 BOERICKE & TAFEl/S 



MILLARD, DR. H. B. The Climate and Statistics of Consump- 
tion. Read before the American Geographical and Statistical Society. 
With extensive additions by the author. 108 pages. Cloth, . 75 cts. 

MOHR, DR. CHARLES. The Incompatible Remedies of the 
Homoeopathic Materia Medica. By Charles Mohe, M.D., Lecturer 
of Homoeopathic Pharmaceutics, Hahnemann Medical College, Philadel- 
phia. (A paper read before the Homoeopathic Medical Society of the 
County of Philadelphia.) Pamphlet, in paper cover, . 10 cts. 

This is an interesting paper, which will well repay perusal and study. It gives a list of 
fifty -seven remedies and their incompatibles, diligently collated from the best-known sources. 

MORGAN, DR. W. The Homoeopathic Treatment of Indiges- 
tion, Constipation, and Haemorrhoids. Edited with Notes and 
Annotations by A. E. Small, M I). 166 pages 12mo. Cloth, 60 cts. 

Diseases resulting from irregularity or debility of the digestive organs are so frequent in 
their occurrence, that scarcely a family can be found in which one or more of its members 
are not sufferers thereby. The present work gives in a concise manner the hygienic meas- 
ures as well as the medical treatment that should be observed, calculated not only to obviate 
the necessity of recourse to dangerous palliatives, but to promote a complete restoration of 
health. 

MORGAN, DR. W. The Textbook for Domestic Practice ; being 
plain and concise directions for the Administration of Homoeopathic 
Medicines in Simple Ailments. 191 pages. 32mo. Cloth, . 50 cts. 

This is a concise and short treatise on the most common ailments, printed in convenient 
size for the pocket ; a -veritable traveller's companion. 

A complete set of thirty remedies, in vials holding over fifty doses each, is furnished for 
$4.50, in stout mahogany case ; or same set in vials holding over one hundred doses each, 
for $6.50 ; or book and case complete for $5 or $7 respectively. Address orders to Boericke 
& Tafel's Pharmacies, New York, Philadelphia, Baltimore, Chicago, New Orleans, or San 
Francisco. 

MURE, DR. B. Materia Medica ; or, Provings of the Principal Ani- 
mal and Vegetable Poisons of the Brazilian Empire, and their Application 
in the Treatment of Diseases. Translated from the French, and arranged 
according to Hahnemann's Method, by C. J. Hempel, M.D. 220 pages. 

12mo. Cloth, . $1 OO 

* 

This volume, from the pen of the celebrated Dr. Mure, of Rio Janeiro, contains the patho- 
genesis of thirty-two remedies, a number of which have been used in general practice ever 
since the appearance of the work. A faithful wood-cut of the plant or animal treated of ac- 
companies each pathogenesis. 

NEIDHARD, DR. C. On the Universality of the Homoeopathic 
Law of Cure, • • 30 cts. 

NEW PROVINGS of Cistus Canadensis, Cobaltum, Zingiber, and Mer- 
curius Proto-lodatus. 96 pages. Paper, 75 cts. 

NORTH AMERICAN JOURNAL OP HOMOEOPATHY. Pub- 
lished quarterly on the first days of August, November, February, and 
May. Edited by S. Lilienthal, M.D. Yol. X, New Series, commenced 
in August, 1879. Subscription price per volume, in advance, . $4 00 
Complete sets of the first twenty-seven volumes, in half morocco binding, 
including Index to the first eighteen volumes, . . . $90 00 
Index to the first eighteen volumes $2 00 



HOMCEOPATHIC PUBLICATIONS. 13 



OEHME, DR. F. G-. Therapeutics of Diphtheritis. A Compilation 
and Critical Review of the German and American Homoeopathic Litera- 
ture. Second enlarged edition. 84 pages. Paper, . . . 60 cts. 
Same, in cloth, 75 cts. 

'This pamphlet contains the best compilation of reliable testimony relative to diphtheria 
that has appeared from the pen of any member of our school." — Ohio Medical and Surgical 
Reporter. 

'"'Although he claims nothing more for his book than that it is a compilation, with 'criti- 
cal reviews,' he has done his work so well and thoroughly as to merit all praise." — Hahne- 
mannian Monthly. 

" Dr. Oehme's little book will be worth many times its price to any one who has to treat 
this terrible disease." — British Journal of Homoeopathy. 

""It is the best monograph we have yet seen on diphtheria." — Cincinnati Medical Advance. 

PETERS, DR. J. C. A Complete Treatise on Headaches and 
Diseases of the Head. I. The Nature and Treatment of Headaches. 
II. The Nature and Treatment of Apoplexy. III. The Nature and 
Treatment of Mental Derangement. IT. The Nature and Treatment of 
Irritation, Congestion, and Inflammation of the Brain and its Membranes. 
Based on Th. J. Eiickert's Clinical Experiences in Homoeopathy. 586 
pages. Half leather, $2. 50 

PETERS, DR. J. 0. A Treatise on Apoplexy. With an Appendix 
on Softening of the Brain and Paralysis. Based on Th. J. Eiickert's 
Clinica ^Experiences in Homoeopathy. 164 pages. 8vo. Cloth, $1 00 

PETERS, DR. J. 0. The Diseases of Females and Married Fe- 
males. Second edition. Two parts in one volume. 356 pages 
Cloth, " $1 50 

PETERS, DR. J. 0. The Diseases of Married Females. Disorders 
of Pregnancy, Parturition, and Lactation. 196 pages. 8vo. Cloth, 

$1 00 

PETERS, DR. J. 0. A Treatise on the Principal Diseases of the 
Eyes. Based on Th. J. Eiickert's Clinical Experiences in Homoeopathy. 
291 pages. 8vo. Cloth, $1 50 

PETERS, DR. J. 0. A Treatise on the Inflammatory and Organic 
Diseases of the Brain. Based on Th. J. Eiickert's Clinical Experi- 
ences in Homoeopathy. 156 pages. 8vo. Cloth, . . . $1 00 

PETERS, DR. J. 0. A Treatise on Nervous Derangement and 
Mental Disorders. Based on Th. J. Eiickert's Clinical Experiences in 
Homoeopathy. 104 pages. 8vo. Cloth, $1 00 

PHYSICIAN'S VISITING LIST AND POCKET REPERTORY, 

THE HOMCEOPATHIC. By Eobert Faulkner, M.D. Second 

edition, , . . . $2 00 

" Dr. Faulkner's Visiting List is well adapted to render the details of daily work more 
perfectly recorded than any book prepared for the same purpose with which we have hitherto 
met. It commences with* Almanacs for 1877 and 1878; then follow an obstetric calendar; 
a listof Poisons and their Antidotes; an account of Marshall Hall's ready method in As- 
phyxia; a Repertory of between sixty and seventy pages ; pages marked for general memo- 
randa ; Vaccination Records ; Eecord of Deaths ; Nurses ; Friends and others ; Obstetric 



14 BOERICKE & TAFEI/S 



Record, which is especially complete ; and finally, pages ruled to keep notes of daily visits, 
and also spaces marked for name of the medicine ordered on each day. The plan devised 
is so simple, so efficient, and so clear, that we illustrate it on a scale just half the size of the 
original (here follows illustration). The list is not divided into special months, but its use 
may be as easily commenced in the middle of the year as at the beginning. We heartily 
recommend Faulkner's List to our colleagues who may be now making preparations for the 
duties of 1878:" — Monthly Homoeopathic Review, London. 

RAUE, DR. 0. G. Special Pathology and Diagnosis, with Thera- 
peutic Hints. 344 pages. 8vo. Half morocco, . . . $5 00 

This standard work is used as a textbook in all our colleges, and is found in almost every 
physician's library. An especially commendable feature is that it contains the application 
of nearly all the new remedies contained in Dr. Hale's work on Materia Medica. 

RUDDOCK, DR. Principles, Practice, and Progress of Homoe- 
opathy, 5 cts. ; per hundred, $3 ; per thousand, . . . $25 00 

RUOFF'S REPERTORY OP HOMCEOPATHIC MEDIOINE. 

Nosologically arranged. Translated from the German by A. H. Okie, 

M.D. With additions and improvements by G. Humphrey, M.D. 251 

. pages. 12mo. Cloth, . . . $1 50 

As a book of reference for the practitioner, the present work far excels every other work, 
presenting him at a single glance what he might otherwise seek for amidst a confused mass 
of records and never find. The indefatigable author has drawn his matter from the infallible 
results of experience, leaving out all guesswork and hypothesis. 

RUSH, DR. JOHN. Veterinary Surgeon. The Handbook to Vet- 
erinary Homoeopathy; or, the Homoeopathic Treatment of Horses, Cattle, 
Sheep, Dogs, and Swine. From the London edition. With numerous 
additions from the Seventh German edition of Dr. F. E. Gunther's "Ho- 
moeopathic Veterinary." Translated by J. F. Sheek, M.D- 150 pages. 
18mo. Cloth, 50 Cts. 

SOHAEPER, J. 0. New Manual of Homoeopathic Veterinary 
Medicine. An easy and comprehensive arrangement of Diseases, 
adapted to the use of every owner of Domestic Animals, and especially 
. designed for the Farmer living out of the reach of medical advice, and 
showing him the way of treating his sick Horses, Cattle, Sheep, Swine, 
and Dogs, in the most simple, expeditious, safe, and cheap manner. 
Translated from the German, with numerous additions from other veteri- 
nary manuals, by C. J. Hempel, M.D. 321 pages. 8vo. Cloth, $2 00 

SOHWABE, DR. WILLMAR. Pharmacopoeia Homceopathica 
Polyglottica. Second edition. Cloth, . . . , . $3 00 
Of this valuable work, the second edition has just been issued. 

SHARP'S TRACTS ON HOMCEOPATHY, each, . . 5 cts, 
Per hundred, . $3 00 

No. 1. What is Homoeopathy? No. 7. The Principles of Homoeopathy. 

No. 2. The Defence of Homoeopathy. No. 8. Controversy on 

No. 3. The Truth of " No. 9. Eemedies of 

No. 4. The Small Doses of " No. 10. Provings of 

No. 5. The Difficulties of " No. 11. Single Medicines of " 

No. 6. Advantages of " No. 12. Common-sense of 






HOMCEOPATHIC PUBLICATIONS. 15 



SHARP'S TRACTS, complete set of 12 numbers, ... 50 cts. 
. Bound. . • • • 75 Cts. 

SMALL, DR. A. E. Manual of Homoeopathic Practice, for the 

use of Families and Private Individuals. Fifteenth enlarged edition. 
831 pages. Svo. Half leather, . $2 50 

SMALL, DR. A. E. Manual of Homoeopathic Practice. Trans- 
lated into German by C. J. Hempel, M.D. Eleventh edition. 643 pages. 
8vo. Cloth, . ' . • • $2 50 

SMALL, DR. A. E. Diseases of the Nervous System, to which is 

added a Treatise on the Diseases of the Skin, by Dr. C. E. Toothacker. 

216 pages. 8vo. Cloth, $1 00 

This treatise is from the pen of the distinguished author of the well-known and highly 
popular work entitled, " Small's Domestic Practice." It contains an elaborate description 
of the diseases of the nervous system, together with a full statement of the remedies which 
have been used with beneficial effect in the treatment of these disorders. 



STAPF, DR. E. Additions to the Materia Medica Pura. Trans- 
lated by C. J. Hempel, M.D. 292 pages. Svo. Cloth, ... $1 50 

This work is an indispensable appendix to Hahnemann's Materia Medica Pura. Every 
remedy is accompanied with extensive and most interesting clinical remarks, and a variety 
of cases illustrative of its therapeutical uses. 

TESSIER, DR. J. P. .Clinical Researches concerning the Ho- 
moeopathic Treatment of Asiatic Cholera. Translated by C. J. 
Hempel, M.D. 109 pages. Svo. Cloth, 75 cts. 

TESSIER, DR. J. P. Clinical Remarks concerning the Homoeo- 
pathic Treatment of Pneumonia, preceded by a Retrospective View 
of the Allopathic Materia Medica, and an Explanation of the Homoeo- 
pathic Law of Cure. Translated by C. J. Hempel, 31. D. 131 pages. 
8vo. Cloth, 75 Cts. 

THOMAS, DR. A. R. Post-Mortem Examination and Morbid 
Anatomy. 337 pages. 8vo. Cloth, . . . . . $2 50 

VERDI, DR. T. S. Maternity ; a Popular Treatise for Young 
Wives and Mothers. By Tullio Suzzara .Verdi, A.M. 3 M.D., of 
Washington, D. C. 450 pages. 12mo. Cloth, . . . . $2 00 

"JNo one needs instruction more than a young mother, and the directions given by Dr. 
Verdi in this work are such as I should take great pleasure in recommending to all the 
voung mothers, and some of the old ones, in the range of mv practice." — Georqe E. Shwman 
J/-.D- Chicago, III. 

** Dr. Verdi's book is replete with useful suggestions for wives and mothers, and his medi- 
cal instructions for home use accord with the maxims of my best experience in practice."— 
John F. Gray, M.D., New York City. 

VERDI, DR. T. S. Mothers and Daughters : Practical Studies for 

the Conservation of the Health of Girls. By Tullio Suzzara Terdi, 

A.M., M.D. 287 pages. 12mo. Cloth, . . , , . $1 50 

"The people, and especially the women, need enlightening on many points connected with 
their physical life, and the time is fast approaching when it will no longer be thought sin- 



gular or l Yankeeish ' that a woman should be instructed in regard to her sexuality, its 
organs and their functions. . . . Dr. Verdi is doing a good work in writing such books, 
anu we trust lie will continue in the course he has adopted of educating the mother and 
daughters. The book is handsomely presented. It is printed with good type on fine paper, 
and is neatly and substantially bound." — Hahnemannian Monthly. 

WILLIAMSON, DR. W. Diseases of Females and Children, 
and their Homoeopathic Treatment. Third enlarged edition. 256 
pages. 12mo. Cloth, $1 00 

This work contains a short treatise on the homoeopathic treatment of the diseases of females 
and children, the conduct to be observed during pregnancy, labor, and confinement, and di- 
rections for the management of new-born infants. 



HOMCEOPATHIC JOURNALS. 



THE NORTH AMERICAN JOURNAL OP HOMCEOPATHY. 

Samuel A. Lilienthal, M.D., Editor. Boericke & Tafel, Publishers. 
Quarterly. Subscription price per year, payable in advance, $4 00 

This is the oldest Homoeopathic Journal in this country, being now in its twenty-seventh 
year. The first volume was published in 1851, under the editorship of C. Hering, M.D., of 
Philadelphia; E. E. Marcy, M.D., and J. W. Metcalfe. M.D., of New York. In 1856, E. 
E. Marcy and J. C. Peters, M.D., of New York ; Wm. H. Holcombe, M.D., of Waterproof, 
La., and H. C. Preston, M.D., of Providence, R. I., appear as editors. In 1860, Dr. J. C. 
Peters, with a corps of assistant editors, assumed charge; and from 1861 until 1869 the late 
Dr. F. W. Hunt virtually edited the Journal, although his name did not always appear as 
such. In 1870, Dr. S. Lilienthal became associated with Dr. Hunt as co-editor, and since* 
1871 Dr. Samuel A. Lilienthal took sole charge of the Journal. 

The Journal had its ups and downs during the long years of its existence, but under the 
administration of indefatigable Dr. Lilienthal it entered on a career of prosperity such as it 
never enjoyed before, and it is safe to say that it never before had as many friends, as vain- 
able original or translated articles, and as large a subscription list. 

The Twenty-eighth Volume of this Journal commences in August, 1879. Subscriptions 
please address to the publication office as follows: 

BOERICKE & TAFEL, 

14S Grand Street, New York. 



ADDENDA. 



PATHOGENETIC OUTLINES OF HOMCEOPATHIC DRUGS. 

By Dr. Carl Heinigke of Leipzig. Translated from the German by 

Emil Tietze, M.D., of Philadelphia. 576 pages. 8vo. Cloth, $3.50. 

This work, but shortly issued, is already meeting with a large sale and an appreciative 
reception. 

It differs from most works of its class in these respects : 

1. That the symptomatic outlines of the various drugs are based exclusively upon the 
"pathogenetic" results of provings. 

2. That the anatomico-physiological arrangement of the symptoms renders easier the 
understanding and survey of the provings. 

3. That the pathogenetic pictures drawn of most of the drugs, gives the reader a clearer 
idea, and a more exact impression of the action of the various remedies. 

Each remedy is introduced with a brief account of its preparation, duration tf act? on, 
and antidotes. 



